In our Year in Review episode, hosts Elizabeth Lippincott and Sandy Durkin distill a turbulent 2025 into the developments that mattered most for Medicare Plans.

You’ll hear a clear breakdown of the year’s biggest compliance and enforcement stories—from DOJ’s kickback allegations against major MA players to CMS’s aggressive expansion of RADV audits, followed by a late‑year court decision that vacated CMS’s extrapolation rule on procedural grounds. We also cover regulatory highlights and the operational realities behind plan exits and non‑renewals, including run‑out obligations and audit exposure that linger long after a contract ends.

The episode closes with what leaders should do now: tighten documentation and vendor oversight, align risk adjustment with care management, and prepare for continued regulatory scrutiny—because stability comes from readiness, not predictability.

In this episode of Health Law Simplified, hosts Sandy and Elizabeth unpack a pivotal federal court ruling that vacates a key CMS rule governing RADV audits in Medicare Advantage. Learn why the court struck down CMS’s extrapolation methodology and elimination of the Fee-for-Service Adjuster, and what this means for MA plans, compliance teams, and future rulemaking. We explore the procedural missteps that led to the ruling, its alignment with broader judicial scrutiny of CMS, and the potential ripple effects across the industry. Plus, hear practical insights on how MA organizations can respond and prepare for what’s next.

This episode of Health Law Simplified explores the recent wave of insurer exits from the Medicare Advantage market, examining why major carriers are leaving and the financial, regulatory, and operational challenges involved. Sandy and Elizabeth discuss the strategic consequences of non-renewal, including CMS contracting bars, notification requirements, run-out responsibilities, audits, and legal risks, while offering practical advice for organizations considering an exit and highlighting the impact on employees, members, and the broader healthcare landscape.