On May 19, 2023, Lieff Cabraser attorney Edward Baker spoke at the American Health Law Association’s Health Plan Law and Compliance Institute in Chicago, where he co-led a panel discussion entitled “A Moving Target: Key Litigation and Regulatory Developments in Medicare Advantage Risk Adjustment.” The panel was designed to provide plaintiff, defense counsel, and compliance expert perspectives on a series off topics:
- The status of FCA cases involving Medicare Advantage risk adjustment and DOJ enforcement trends more generally;
- Recent changes to the Medicare Advantage risk adjustment payment model and how they reflect and might impact litigation and oversight;
- Announced changes to CMS and OIG RADV Audits and recent trends in focus and approach; and
- Challenges and opportunities for Plans, Providers, and Third Parties in the MA ecosystem.
The Health Plan Law and Compliance Institute designs programs specifically for in-house counsel, compliance officers, and privacy officers at health plans and payers as well as their outside counsel and advisors. Speakers addressed topics such as value-based contracting, “No Surprises Ace,” RADV Audits, data governance for cybersecurity, prior authorization, health plan regulatory updates, and more. The presentations sought to provide in-depth analysis of legal, regulatory, and compliance issues faced by health plans, and practical solutions for addressing these challenges.
For more information and to view the full conference agenda, visit the event website.
About Edward Baker
Edward Baker is Of Counsel at Lieff Cabraser Heimann & Bernstein, LLP. He previously served as an Assistant U.S. Attorney in the Eastern District of California, where he was the Civil Healthcare Fraud Coordinator, as well as the Elder Justice Coordinator, within the Affirmative Civil Enforcement practice group. As an AUSA, Mr. Baker investigated numerous FCA cases, including allegations against physicians for medically unnecessary procedures, pharmacies for kickbacks to nursing homes, defense contractors and federal grant recipients for fraudulent billing, and hospitals for up-coding. He was the lead attorney for the United States in an FCA settlement against a group of Fresno cardiologists for performing medically unnecessary nuclear scans, and in a qui tam settlement against Omnicare, Inc., a national long-term care pharmacy, for improperly submitting claims for prescription drugs dispensed to patients in skilled nursing facilities. He worked closely with criminal prosecutors to enhance the district’s parallel proceedings practice and coordinated regular meetings of the EDCA Healthcare Fraud Task Force.
Prior to serving as an AUSA, Mr. Baker was an Assistant Attorney General for the State of Vermont, where he was the Director of the Medicaid Fraud and Residential Abuse Unit. He was a member of the litigation table team for thirty-six states in a qui tam lawsuit against Wyeth and Pfizer for Medicaid pharmaceutical “best price” violations that ultimately resulted in a $785 million settlement. He also laid the groundwork for the enactment of the Vermont False Claims Act and held leadership positions within the National Association of Medicaid Fraud Control Units.