May 27, 2026
The Hospital Contract Playbook: Four Clauses That Turn Market Power Into Higher Prices. Episode 513.
Across the country, hospital systems have used their growing market power to write four specific contract terms into their deals with insurers — terms that all but guarantee higher prices for employers, unions, and...
May 27, 2026
A Lawyer’s Field Guide to Rent-Seeking Broker and EBC Payment Models. Epsiode 512.
Brokers and employee benefit consultants often get compensated in ways health plans never fully see — and even when the dollars are technically disclosed, the math can hide an enormous overcharge. In this episode, Stacey Richter...
May 14, 2026
When Risk-Based Payment Becomes Its Own Upcoding Arms Race. Episode 511
Medicare Advantage plans get paid more for sicker patients, which is why upcoding became a problem — and now health systems are upcoding visit complexity right back, with MA plans automatically downcoding in response. In this episode, Stacey...
May 7, 2026
The Line Between Fair Profit and Profiteering in Medicare Advantage. Episode 510
There’s a simple test for telling a fair profit from profiteering in Medicare Advantage: does the carrier make more money when the patients it serves are worse off? In this episode, Stacey Richter talks with Betsy Seals, co-founder of...