Helaine I. Fingold, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Baltimore office, was quoted in AIS Health, in “Trump 2.0 Faces Lingering Legal Questions Regarding RADV Audits, Stars, Broker Pay,” by Lauren Flynn Kelly. (Read the full version – subscription required.)
Following is an excerpt:
As field marketing organizations and Medicare Advantage insurers filed multiple legal challenges to federal rulemaking, 2024 was a particularly litigious year for program stakeholders. Now, with the return of Donald Trump to the White House, the new administration must contend with critical questions about MA plan payments to agents and brokers, the calculation of Part C and Part D Star Ratings and the recoupment of overpayments to MA plans. Two leading managed care attorneys tell AIS Health, a division of MMIT, that the resolution to these questions may depend on the administration’s appetite to defend the rulemaking of the prior administration. …
In Texas, where the court is handling the FMO lawsuits together, one overarching question is whether the new administration “is even going to want to pursue this case,” remarks Helaine Fingold, member of the law firm Epstein Becker Green. The July ruling delayed two key provisions of the 2025 CMS rule until the issues can be fully briefed and the court issues a decision. “It’s a little bit of a strange posture because at this point the court hasn’t ruled on the case, [it’s] just granted this preliminary injunction, so it’s not clear procedurally how this will play out, even if the administration didn’t want to continue to defend on this.”
Although the new administration could pull back the regulation and issue a revised one, that would likely be a longer process than just proceeding with the court case and having the court render a decision, suggests Fingold. “If the administration came in and didn’t want to actively support those [provisions], they could certainly file something in agreement that those provisions are wrong .... And it does seem like those are areas the incoming administration is not going to want to push on or try and fight for.”
People
- Member of the Firm