In this episode of AHLA's monthly series on fraud and abuse issues, Matthew Wetzel, Partner, Goodwin Procter, speaks to Kim Brandt, Partner, Tarplin Downs & Young LLC, about her path to public service, some of the lessons she’s learned from her different positions within the government, the importance of good mentors and large networks, and her thoughts on some of the current hot topics in health care. Kim’s long career in government has spanned leadership positions at CMS, OIG, and Capitol Hill, and culminated in her position as Principal Deputy Administrator for Operations and Policy at CMS from August 2017 to December 2020, where she ran the agency’s day-to-day operations. From AHLA's Fraud and Abuse Practice Group. Sponsored by BRG.
Read more about Kim’s journey and experiences in the September 2021 issue of Health Law Connections magazine.
Listen to the July 2021 episode, which discusses career journeys to compliance.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
In this episode of AHLA's monthly series on fraud and abuse issues, Matthew Wetzel, Partner, Goodwin Procter, speaks to Kim Brandt, Partner, Tarplin Downs & Young LLC, about her path to public service, some of the lessons she’s learned from her different positions within the government, the importance of good mentors and large networks, and her thoughts on some of the current hot topics in health care. Kim’s long career in government has spanned leadership positions at CMS, OIG, and Capitol Hill, and culminated in her position as Principal Deputy Administrator for Operations and Policy at CMS from August 2017 to December 2020, where she ran the agency’s day-to-day operations. From AHLA's Fraud and Abuse Practice Group. Sponsored by BRG.
Read more about Kim’s journey and experiences in the September 2021 issue of Health Law Connections magazine.
Listen to the July 2021 episode, which discusses career journeys to compliance.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
The following message and support for A H L A is provided by Berkeley Research Group, a global consulting firm that helps organizations advance in the areas of disputes and investigations, corporate finance and strategy and operations. BRG helps clients stay ahead of what's next. For more information, visit think brg.com.
Speaker 2:Good morning, good afternoon, good evening, and welcome to the American Health Law Associations Fraud and Abuse podcast. I'm your host, Matt Wetzel. Our episode today is the second in a series of podcasts we're recording about careers and health law, and in particular, fraud, abuse and compliance. For those of you who don't know today's test, Kim Brandt, you will absolutely want to, after our interview, Kim's career is unmatched, unparalleled, and unrivaled from serving in key leadership roles within the h h s Office of Inspector General to leading the C M s Medicare Program Integrity Group, to handling healthcare oversight for the Senate Finance Committee, and serving as c m s Principal Deputy Administrator Kim has done it all. She's played a key role in many of the legal, regulatory, and policy matters affecting the healthcare delivery system for decades. And since leaving c m s in December of 2020, Kim is now a partner in the Washington DC-based policy firm, Tarplin Downs and Young, where she advises clients on a wide range of healthcare, regulatory and policy issues. And for our listeners who are active American Health Law Association members, you can catch a fuller interview with Kim as part of our September, 2021, a h l A Connections Magazine, uh, interview. Welcome, Kim. Um, but I, I thought, you know, maybe we could just get started from the beginning. You know, we spoke a couple of weeks ago and you shared some of your experiences in public service and a call that you heard and answered from an early age. So tell us what public service means to you, Kim.
Speaker 3:Sure. I, to me, public service is really being able to give back to your community in different ways. And for me, um, I started as a page in the US Senate when I was in high school, and had the very, uh, good luck, uh, to be able to go to the Vice President's mansion while I was there when, um, George W. Bush, senior HW Bush was president, and he gave us a little lecture on the porch while Barbara Bush served cookies and lemonade about how there is no greater calling than public service. And how being able to give to your country and give back to your fellow Americans is one of the greatest callings you could do. And it really imprinted on me. I was, you know, just in high school, I was 15 years old. I, you know, really thought, wow, that is an amazing calling. And so, um, over the years I ended up doing several internships on Capitol Hill, had the chance to see firsthand, um, how people were giving back to their government. And so when I had the opportunity right outta law school to go into government, it seemed like the logical thing to do because I really wanted to help people. And my original plan of being a doctor didn't work out because I fainted the sight of blood. So here we are,<laugh>.
Speaker 2:Wait. And you mentioned, um, in, uh, our upcoming Connections article, um, that one of your first jobs was as a candy striper. And I wonder if there's a patient-centric component to that and to the work you've done in health law that drives you and is a mission for you.
Speaker 3:You know, there really is to a certain extent, as I mentioned. Um, I originally thought that I wanted to be a doctor because I really wanted to help people. And I really like to find ways to, to be helpful. So I, uh, got a, a position as a candy striper at our local hospital, and I really loved being able to work with the patients and bring them joy by bringing them flowers or bringing them just even, you know, treats or things like that. Um, and, and, and I think that, you know, really what that instilled on me and really kept through as I went to Capitol Hill and then ultimately h h s, was the fact that, you know, the work that I was working on really impacted people in a meaningful, positive way. And that's really what I decided I wanted to do for my career.
Speaker 2:And, you know, one of the reasons we're, uh, even talking today is a focus that worked, you know, trying to, trying to, to move here on, uh, you know, health law, careers and fraud and abuse and compliance careers and, and, and, and the driving factors there. And so it sounds like, you know, the combination of the call to public service and the patient-centric mission has been so pivotal for you. Um, you know, I think it would be a real, um, benefit, Kim, for our listeners to hear about your career path and just, you know, some snippets about each, um, different role that you've had. For folks who don't know you, you've had the great opportunity to see, uh, the healthcare delivery system from so many different chairs and angles. And so, you know, I wonder if you might kinda walk us through what you've done on the health law side and some of the lessons learned from each position that you've held.
Speaker 3:Sure. Um, I'll, I'll try and be succinct about it.<laugh>, it's been an interesting path and I've had a few different twists and turns. Um, but my first job straight outta college was actually on Capitol Hill, working on the house side while I was going to grad school in dc and I worked for my local member of Congress and started out during, uh, flags tours and passports, which was not health law related, but then fortuitously, um, the staff churn is pretty great on the hill. And, um, I moved up within a few months and started covering different issues, ultimately getting to do healthcare issues for him. And he was on the Energy and Commerce Committee, which was a fairly major player at the time, because in the mid nineties, which is when I was doing that, it was Hillary Healthcare reform time. So I just fortuitously lucked into doing healthcare just as that whole issue was popping. I knew absolutely nothing about health law. I had really no interest in it at the time. Um, but, you know, know, started to really see firsthand how those health policies were really interesting and meaningful, and kind of hit on all the things that we talked about that I really liked in terms of, wow, this makes a difference in people's lives. So ultimately, um, I decided at that point that as soon as I was done with grad school that I was going to go to law school. I had actually for Gone law school, but doing, um, the healthcare work made me realize, okay, I really wanna go to law school. And so that led me, uh, to do a health law degree at DePaul College of Law, and then ultimately come back to um, dc. But during law school, I was able to work at Rush Presbyterian Medical Center and Sidley and Austin, now Sidley, um, doing health lot issues and impact. Worked on Northwestern University's very first compliance program as a law school associate, um, in law school, um, which was really awesome to kinda see the business side of healthcare with ul. I then was lucky enough to get hired by H S s OIG G in their office of council, and worked with the fabulous, uh, Larry Goldberg and many other talented people there. Um, and was able to really start seeing, um, okay, here's ways that you can really give good guidance and really help people to understand the rules and hopefully, um, actually adhere to the rules. Um, worked on several healthcare fraud cases, which really showed me the underbelly of healthcare, um, and some of the people who are really deliberately taking advantage of the system. But it also showed me how many people were trying really, really hard to do the right thing, which is what led me to actually, um, help write and be the lead author on the physician compliance guidance. Um, which was my first big thing that I had published post law school. So I was excited about that. And I spent time in a physician's office, my local physician's office back in Ohio for that, and realized firsthand that for that one physician and his staff of a whopping three people, they had no idea how to keep up with all these rules and regulations. And it was really tough for them. And what I also learned while being at the OIG was the OIG sort of had the mindset that c m s and, um, the people who are doing the roles were a bunch of idiots who really didn't know what they were doing, sorry, oig, friends<laugh>. But there was this kinda mindset that, you know, basically thank goodness the OIG is there to save the healthcare system from not only all these bad and non-compliant people, but also from the people who don't know the programs. So sort of where you sit is what you see. So then I moved to c m S and became the director of program integrity and saw the impacts firsthand of all of that, um, abuse and sort of what that meant for the healthcare program as a whole, and how that those dollars lost were dollars that we couldn't use to help our beneficiaries. So really worked very hard over the seven years I was there. Um, you know, with the C M s people who were not quite as misguided as others, might've thought they were<laugh>, but instead at cns, part of the problem was you had Congress, you had o i, you had g a o, you had, um, patient groups and outsiders, everybody telling you what to do. And to be honest, there was only so much that they could do to really respond to that because they were sort, sort of getting pulled in multiple directions, if you will. So again, they were trying to do the right thing, but it wasn't always easy given all of those competing demands. But in, in reality, I was sort of like the Chief compliance officer for c m s for those seven years mm-hmm.<affirmative>. So it was about how it was that I could try and keep us compliant, particularly when we were receiving all these friendly letters from Senator Grassley telling us how much that we were not doing a good job all the time,<laugh>. So with that, um, I had a great career and in 2010 I thought, it's enough. It's time for me to go out, do something else. Cause I had a very brief five months sojourn into private practice at Austin and byd and, um, loved it and was really happy working with providers. And once again, I had the perspective of, wow, these providers, they really are trying to do the right thing, but a lot of these government regulations are written so that it's very hard for them to understand, particularly the Stark Law. And there's a lot of issues there. So again, I thought, well, I wish I could do more. And then that led me to, in January of 11, uh, going over to the Senate Finance Committee. I didn't mean to leave private practice so quickly, but the chance to go and be the person who wrote the letters to c m s that they had to respond to after I hire to respond to them for so long was really too good an opportunity to pass up. And so for seven years, um, almost I went back to the finance committee, worked there as Senator Hatch's Chief Oversight Council, um, and then running the Medicaid portfolio there for much of that time. And what I realized then was that, you know, Congress also has a really important role. They're trained to do things that they think are in the best interest of their constituents. And because I was now in a much more senior role than I was on the house side, I also realized that they had the impact or the ability to really impact in a meaningful way, the policies. And they could make policies that hopefully we'd be better so that c m s could write better laws so that OIG would have better authorities to enact in. And it really kind of all came full circle, if you will. And then that led to finally, sorry, I told you it was a twisty road<laugh>. Um, finally me coming back in August of 2017 to c M s when I had the very good opportunity to be asked to be Suma Burma's deputy and basically run the day-to-day operations at C M s in addition to doing cross-cutting policy across the agency for her, which honestly was probably the capstone of everything that I had done in government, because it really allowed me to take all those different perspectives and everything I had learned and bring it to bear in a meaningful good way so that I was able to help lead things like interoperability and the new interoperability rules that we issued at C M s. I was very thrilled to be part of the team and leading the technical team that redid the Stark regulations, cuz that had been something I cared about for a long time. And being able to put those into plain English and working with the technical team to really make those changes was a huge thing. And then also just being able to work on a lot of the other good and sort of practical, um, things that we did across the board at C M S to make it so that it was easier for healthcare providers to get data and understand data and things like that. It really just kind of felt like, like a, a good way to bring all of my skills and everything I've learned all together. So that's my path. Matt
Speaker 2:<laugh> Kim, that what a, what a story and, and really, I mean, you know, what I, what I heard you say in telling your path was, you know that your, your interest was in understanding your stakeholders and what Yes. What their needs were. Educating stakeholders on different compliance, legal, regulatory issues, um, recognizing that the different players in the different parts of the healthcare delivery system tend to have, you know, positive missions and positive goals for their actions and bringing folks together so that they understand what other parts of the system are doing. And you said something just now and you say it in the, in the interview, uh, in the Connections article, um, uh, where you sit is what you see. I love that expression. It's my new favorite expression.<laugh>. Tell me, tell me about that and, and, and what that means to you.
Speaker 3:So I think it's really true. I mean, every single place that I worked, I really, you know, where I was working gave me a whole new perspective on things. And I think that, you know, one of the challenges many of us have in our careers is that we don't often get to see those different perspectives. I've been very lucky. I've worked on the house and the Senate side, I've worked in the executive branch, I've the legislative branch, I've worked with stakeholders, and I think each of those perspectives bring something new to the table. And to your point, one of my big takeaways from my government career was I really wanted to be able to do things in a positive, meaningful way that could help the people impacted. And it's the stakeholders, it's the patients, it's sometimes even the other regulators. And honestly, to be able to do that, you really have to sit in those different chairs and really understand their perspective. And without that, I think it's really hard to be able to make meaningful changes or to really be able to, um, think thoughtfully about what good solutions are. So that's why I really like where you sit is what you see, because that perspective, it's very jaundice despite where you sit, basically.
Speaker 2:Absolutely. No, I, I think that's great. And tell us, um, one way in which your perspective changed at oig, uh, on the Hill and at C M S.
Speaker 3:Sure. I think at OIG there was a presumption that there were people that were just out there to get the government, and that everybody kind of had a nefarious mindset. And again, you had to keep in mind these are people who, their job is to root out the worst of the worst healthcare fraud. So they're, I, I mean,
Speaker 2:They, they see the bad cases, they
Speaker 3:See the bad fraud cases, bad cases. So again, where they sit is what they see. So they're very much of the opinion that CMS is rather ill-equipped to handle what they do, and they don't necessarily understand why they aren't more vigilant on a lot of their anti-fraud things. And also, I think that they were very much of the opinion that the healthcare community as a whole doesn't really care that much about compliance or education. I truly believe that until I left oig, and then again, when I went to C M s, what I realized was c m s number one cares about their beneficiaries. The people at C M S are some and OIG too, but these are some of the most dedicated public servants I have ever known. I mean, the people at C M S really are trying to, you know, write rules that hopefully make sense, that protect beneficiaries, that give them, you know, the best possible, um, access to care, but also hopefully are going to make it so that the providers have the tools they need to provide for those beneficiaries. And that's really important to them. They care about that a lot. But I think c m s also gets very frustrated because they've got, again, these oversight people on the hill and the, uh, OIG and others that are constantly looking over their shoulder. So then going to the Congress, I thought, well, gosh, all they do is sit there and pick on the poor administration all day. But what I realized is that they feel like they have a duty, um, much like the OIG feels, they have a duty to sort of protect the programs. And so part of that is they wanna make sure and make laws and make policies that hopefully not only will help the beneficiaries who are ultimately their constituents, but also to make sure that they're providing good tool tools to help provide the best care possible. And that's a big part of what they think when they legislate. So again, with each of these perspectives, you know, sort of the, but ultimately what Congress I did learn from them is that Congress is above everybody and they really don't care what anybody else thinks. So they, you know, at the end of the day, O A G C M S, everybody else does whatever Congress tells them to do. So the, the thing is, being at Congress is probably the best job ever because you have the biggest bully pulpit and the biggest authority. But yet by the same token, they feel that responsibility because they feel accountable to that, to their constituents who are both the providers and the beneficiaries.
Speaker 2:Absolutely, absolutely. No, switching gears just a little bit, you know, one of the things we'd like to, uh, move forward here with our, our podcast series is Careers and Health Law. So we've heard where you sit is what you see, but one of the things I think readers will find when they read the Connections article next month is, um, your passion for mentoring. You've worked with some of the best health lawyers out there, Kim, um, and many high profile policy makers, you know, people, uh, who are, you know, uh, names that you know, uh, uh, uh, everyone knows in the American public. Um, and, and you've worked with folks who are legends of the bar. Tell tell us who are your mentors and what have you learned from them?
Speaker 3:It's a great question. I would be remiss if I didn't start with Larry Goldberg, who many of you know, we used to be the principal deputy inspector at the oig. Uh, he was my first boss at the office of Inspector General, is still the number one person I go to whenever I need advice on anything. Great. And, um, he was just a great mentor because he really showed me how to treat the people that work for you, um, with respect and dignity, but also to be a resource and mentor them and help them to understand how to be a better lawyer and a better person to a certain extent. Mm-hmm.<affirmative>. And what he taught me in terms of his management style and his legal style early on, i, I credit for a lot of my success in my career because just the way that he was, um, very thoughtful, but, um, you know, direct, um, he held you accountable. Um, he would give me grief anytime he found a typo,<laugh>, um, which, you know, I went for almost six months without a typo under his watch. And then when I had one, he was very quick to let me know it, but you know, he held it to a high standard. But he also was really good about helping you rise to that next level and support you. Um, I think another person who I'd be remiss if I didn't, um, mention was Howard Young, who also worked with me at the OIG G. And, um, Howard was the first attorney boss that I had, and he really taught me how to write succinctly and to really think about analyzing fact patterns in a really good, um, productive way. And that skill, even though I'm not necessarily a practicing lawyer anymore, it has helped me invaluably through the years. And I think Howard was one of the first people to really help me think about those different perspectives, as you will. He was really good about looking at it from multiple perspectives, what's the provider perspective, what's the patient perspective, and then, okay, how are we gonna go after the bad guys? Um, so that was really good as well. And then lastly, um, you know, I, I think that honestly, it's kind of a combination of people, but, um, I really did learn a lot from a couple of c m s administrators that I've worked with, including Tom Scully. Mm-hmm.<affirmative>. Um, I've had the pleasure of working with Tom in multiple capacities. I worked for him briefly when I first started at C M s and then, um, have worked with him on multiple things since he's one of the smartest policy people I've ever had the pleasure of interacting with his ability to really foresee what's happening in the healthcare industry and thinking about how that impacts all the stakeholders in the system and how that impacts both the legislative and regulatory side. It's truly impressive and it really has helped me to always keep that perspective in mind. And then the last person I mentioned is Mark McClellan. Mm-hmm.<affirmative>, um, Dr. McClellan was the first real administrator I worked for. Again, Scully was there just briefly at the beginning of my tenure, but for much of my first, uh, career at C cms, uh, Dr. McClellan was the administrator and his just brilliance in healthcare policy, the way he executed, um, the development of the Medicare Modernization Act and just sort of how he approached things. It taught me so much that I realized that I was able to draw on when I came back in 2017, several years later. But also what I loved about it was he always wanted to know what everyone thought, no matter what level they were at. I was a junior person at c m s, junior, senior executive when he was there, but yet he always took the time in a meeting to be like, well, Kim, what do you think? And what are your views? And it really impacted me because it was a great way to sort of, um, see how a leader can really bring in and bring out the best in all of the people who work for them.
Speaker 2:Absolutely. No, that's great. Kim. Um, when we talked a couple of weeks ago, uh, one, uh, thing you mentioned, we were talking about sort of advice for younger lawyers and, uh, you know, uh, uh, uh, sort of, you know, what are are some tips and recommendations you'd make at this end of your career to, you know, folks who are just kind of starting out? And you mentioned networking. Tell me about networking.
Speaker 3:So networking is my superpower. I like to say, um, I, and most of you who know me know that I love to talk to people, I love to meet people and I try to be really good at keeping in touch. And I will say that the biggest thing that has helped me in my career has been a wide network. Um, I've been so grateful over the years to have people like Katie McDermott and, um, you know, other senior attorneys, Elizabeth Carter Thompson, and others who were people that were kind to me early on in my career who I kept in touch with and who were kind enough to keep in touch with me and who really helped, um, to be able to grow my network and give me those resources so that when I had big decisions to make or when I had things that I wasn't quite sure how to approach, I could go to and they could give me really good advice. As I mentioned, Larry Goldberg is perhaps my biggest network and mentor because it was really, uh, through him that I was able to get into all of this. But I think that, you know, the importance of a big network is that then you always have a whole safety net of people that you can go to for any issue. And I find that, particularly now that I'm out of government, I appreciate that network more than ever because I come up with issues on a daily basis that frankly I don't always know what the answer is. And having that network is a great way to be able to bring it in, but there are also people who are gonna help you move up and grow in your career. And that is so critically important. So my number one advice to everybody is grow a good network and maintain it. It takes a lot of effort. It is not easy cuz you kind of have to, it's like a garden, you have to tend it to have it grow. Um, but it, it's honestly, having a wide and diverse network is one of the best things that you can have for your career.
Speaker 2:That's such great advice, Kim. And, um, I, I certainly second that, uh, from my own experience, uh, and, uh, and you named a couple of names in there that are, you know, mentors of mine as well. So it's, it's nice to know that, um, you know, there's a full circle network, uh, in, in our world here. And, um, you know, I thought maybe one thing we could do, Kim, so that, you know, we can talk a little substance on the health, on the health loss side is maybe just do a quick round robin of a couple of hot button topics right now and just get your immediate reaction to it and your thoughts, if that's okay with you.
Speaker 3:Uh, perfectly fine. I, I'm excited. Feels like Okay. A jeopardy round or something, so. Yeah,
Speaker 2:Exactly. Exactly. Alright. Right. So expanding, um, telehealth and telemedicine coverage, what are your thoughts?
Speaker 3:Um, absolutely think it needs to be done. I, I think that the one caveat to that is from a program integrity perspective, there does need to still be periodic check-ins to establish that, uh, relationship between the patient and the the provider. But otherwise, I think the opening and expansion of telehealth is perhaps the best thing in the thing I'm most proud of that we did at C M S during the pandemic is absolutely changed the whole game in terms of ability to provide care, particularly in underserved areas and in particular for mental health. Um, mental and behavioral health have just benefited a lot from this, so I hope it stays.
Speaker 2:That's great. That's great. Um, the value-based, uh, regs under Stark and under, uh, the anti-kickback statute, your thoughts?
Speaker 3:Well, obviously they're brilliant, but anyway, um, but no, I, I, I do think I'm super proud of the work that both teams did on those, and honestly, I hope that the provider community and the legal community also feels that those were positive, um, impactful changes. Um, the, you know, almost three years that the team spent working on those to make them understandable, more relevant, and hopefully less cumbersome for the provider community, I think really does show in the final regulations. Um, they're not perfect cuz nothing ever is, I realize there's still tweaks and changes to be made, but for me that was the culmination of an almost 10 year journey of trying to make changes to the stark, uh, regulations or the underlying Stark law so that hopefully we could get to a place where there was more plain English definitions, better assumptions of how to do care coordination and the ability to really give people the, um, pathway forward on value-based care without fear of any sort of retribution or legal action.
Speaker 2:Uh, and then finally, um, price transparency for hospitals and providers.
Speaker 3:So that one I'm watching with great interest because I think a lot of it depends on how serious c m s gets about penalties. Um, as you know, they have proposed tougher penalties in their most recent round of rulemaking. Um, I think that that is necessary and if they don't do that, I think that unfortunately, I don't know that price transparency will ever get to where congress or, uh, the original executive branch sponsors of this, uh, want it to get. Um, as it stands right now, I, I think hospitals are a mixed bag in terms of their compliance with that. And in order to get to true compliance, it's going to need to be enforced more readily, but they're also gonna have to be able to have things posted in ways that people can actually read it. I've seen some of the things that hospitals have posted that allegedly comply with the price transparency and I can't understand them and I feel like I have a fairly good understanding of how to read that kinda stuff. So I, I do think it's, it's a two-pronged approach. It's gonna be greater enforcement, but it's also gonna be a greater, um, education effort across the board to make it so that hopefully whatever they post is going to be understandable to the patients who actually would benefit it. Because I can tell you the average patient probably isn't gonna understand most of what's up there right now.
Speaker 2:Absolutely. Absolutely. Kim, thank you so much for the time today from your public service mission to your mission, to educate and connect stakeholders, networking, mentoring, uh, and uh, and of course my favorite expression, where you sit is what you see. Um, really we appreciate you, uh, taking the time to join us. Appreciate it.
Speaker 3:No problem. It was my pleasure. Thanks for having me and uh, I look forward to talking to you again
Speaker 2:Soon. Absolutely. Thanks Kim. Thank you to the Berkeley Research Group, our A H L A fraud and abuse podcast sponsor. And a special thanks to our listeners for tuning in. We'll be back next month with another edition of the Fraud and Abuse podcast. Thanks so much.
Speaker 4:Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L A speaking of health law wherever you get your podcasts. To learn more about a H L A and the educational resources available to the health law community, visit American health law.org.