Payers, Providers, and Patients – Oh My! Is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors. In this episode, hosts Payal Nanavati and Joe Records sit down with Xavier Baker and Kevin Kroeker to discuss medical loss ratio. This episode touches on what an MLR is, some of the history of MLR requirements in health coverage, and some of the similarities and differences across markets. Stay tuned for Part 2.

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Photo of A. Xavier Baker A. Xavier Baker

Xavier Baker is a partner in Crowell & Moring’s Health Care Group and is located in the Washington, D.C. office. He advises clients on health care insurance and managed care regulations, investigations, transactions, and litigation. He counsels national and regional health insurers, pharmacy…

Xavier Baker is a partner in Crowell & Moring’s Health Care Group and is located in the Washington, D.C. office. He advises clients on health care insurance and managed care regulations, investigations, transactions, and litigation. He counsels national and regional health insurers, pharmacy benefit managers, care coordination organizations, and other specialty health care service providers and trade associations on complex regulatory issues.

Photo of Kevin B. Kroeker Kevin B. Kroeker

Kevin Kroeker is a partner in Crowell & Moring’s Los Angeles office, and is a former co-chair of the firm’s Health Care Group. He represents health care organizations on a wide range of state and federal regulatory matters and health care transactions. Kevin…

Kevin Kroeker is a partner in Crowell & Moring’s Los Angeles office, and is a former co-chair of the firm’s Health Care Group. He represents health care organizations on a wide range of state and federal regulatory matters and health care transactions. Kevin has more than 30 years of experience representing a diverse array of health care entities and stakeholders, including managed care plans and insurers, Medicare Advantage Organizations, Medicaid Managed Care plans, hospitals, medical groups and community clinics. Kevin has served on several nonprofit boards and he counsels nonprofit organizations in connection with governance and compliance issues. Kevin has guided numerous health plans and providers through the regulatory complexities of merger and acquisition transactions.

Photo of Joe Records Joe Records

Joe Records is a counsel in the firm’s Washington, D.C. office, where he practices in the Health Care Group. Joe’s practice includes counseling and representing clients on a broad array of regulatory matters, frequently dealing with federal health care programs, health reform, and…

Joe Records is a counsel in the firm’s Washington, D.C. office, where he practices in the Health Care Group. Joe’s practice includes counseling and representing clients on a broad array of regulatory matters, frequently dealing with federal health care programs, health reform, and state regulation of payers and providers. In particular, Joe has advanced clients’ interests by developing legislative and regulatory health care proposals at the federal and state levels and has helped clients evaluate the impact on their business of other proposals. He has also worked with clients to respond to federal audits, including under federal health care programs, and assisted in structuring transactions to comply with state and federal law.

Photo of Payal Nanavati Payal Nanavati

Payal Nanavati is an associate in the firm’s Washington, D.C. office, where she practices in the Health Care and Government Contracts groups. Payal’s government contracts practice focuses on contract claims/disputes under the Contract Disputes Act (CDA), litigation before the Armed Services Board of…

Payal Nanavati is an associate in the firm’s Washington, D.C. office, where she practices in the Health Care and Government Contracts groups. Payal’s government contracts practice focuses on contract claims/disputes under the Contract Disputes Act (CDA), litigation before the Armed Services Board of Contract Appeals (ASBCA), and bid protests before the Government Accountability Office (GAO). Her health care practice includes regulatory compliance governing digital health initiatives and fraud and abuse.