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Medicare Supplement (Med Supp, a/k/a Medigap) guaranteed issue rights have become a hot topic. Even late-night comedians are talking about the challenge faced by people in Medicare Advantage (MA) for more than a year who would like to return to Original Medicare and purchase a Med Supp policy.

Hear the story behind our founding and mission. Elizabeth Lippincott shares how it all began. Attorney Advertisement. This video is for informational purposes only and should not be considered legal advice.

By Sandra Durkin Health plans wondering what type of oversight to expect from the new administration can anticipate continued scrutiny of risk adjusted payments to Medicare Advantage organizations. While Trump has said that he will “love and cherish” Social Security and Medicare and does not plan on cuts to those programs, he more recently [...]

By Elizabeth Lippincott The Inflation Reduction Act Part D redesign was not intended to boost enrollment in Medicare Advantage plans, but that is a likely outcome of the IRA’s changes to Part D. The IRA statutory language capped increases in a Part D premium benchmark at 6% per year, but did not cap the [...]

In a report issued in October 2024, the Office of Inspector General (“OIG”) within the Department of Health and Human Services (“HHS”) expressed concern that health risk assessments (“HRAs”) and chart reviews used by Medicare Advantage organizations (“MAOs”) are being misused to drive up payments from the government, rather than to improve member care.

On August 1, 2024, the U.S. Department of Justice (DOJ) introduced its Corporate Whistleblower Awards Pilot Program, a three-year program designed to fill gaps in federal agency whistleblower programs. A key function of this new program is to bolster enforcement of misconduct that is not prosecutable under the False Claims Act (FCA). The FCA only imposes liability for fraud against the federal government, which creates a gap in enforcement for fraud against other organizations or individuals. The Whistleblower Pilot Program targets misconduct against non-federal government organizations or individuals, such as private payors or patients.

On July 18, 2024, the Centers for Medicare & Medicaid Services (CMS) published an update to the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance (Updated Guidance). CMS had not updated guidance for organization determinations, appeals, and grievances (ODAG) in the Part C program and coverage determinations, appeals and grievances (CDAG) in the Part D program since 2019. The Updated Guidance reflects recent changes to the regulations governing ODAGs, clarifications on the role of representatives in the ODAG/CDAG process, and terminology changes to align with updated regulations.

The pendulum of the Medicare plan regulatory environment—which grew increasingly stringent under the Biden administration—probably reached its amplitude in the last few weeks and began to swing in the opposite direction. Having seen several oscillations of this political pendulum, I wanted to share some insights about what these changes mean for Medicare plans, as well as what lawyers and business teams can count on to stay constant.

A Texas District Court has stayed the implementation of the Medicare Advantage and Part D agent compensation provisions of the CY 2025 Final Rule for all affected parties.