At Medscholaria Consulting, we stand at the intersection of healthcare compliance, utilization management, ethics, and public trust. Recent developments — both at the federal and state levels — show that the need for strong, ethical frameworks in healthcare is not optional. It’s urgent.
Today, I want to highlight two critical policy issues that showcase why Medscholaria’s mission is more necessary than ever, and how our expanding services will meet these challenges head-on.
Medicare Advantage: When Influence Undermines Integrity
In late 2024 and early 2025, new court filings and lobbying reports revealed something both shocking and deeply consequential: Medicare Advantage (MA) insurers, including some of the largest names in healthcare like UnitedHealth, have been actively working to shape federal health policy in ways that protect their financial interests — even at the expense of taxpayers and patients.
The focus of this lobbying machine?
Efforts to weaken audit processes and maintain favorable risk-adjusted reimbursement structures that allow for significant overbilling.
Risk adjustment coding — a legitimate tool meant to reflect patient complexity — has been exploited. Insurers have allegedly exaggerated patient conditions, securing higher reimbursements while distorting the true picture of Medicare beneficiaries’ health needs.
The implications are profound:
- Taxpayer resources are misallocated, reducing funding available for other critical healthcare programs.
- Beneficiaries may face more restrictive care, as insurers try to offset potential audit liabilities by cutting services.
- Public trust erodes, weakening the integrity of both public and private healthcare systems.
At Medscholaria, we view this not just as a cautionary tale — but as a strategic opportunity to lead.
Our consulting practice is preparing to:
- Support ethical utilization management (UM) practices that align with Centers for Medicare & Medicaid Services (CMS) expectations.
- Provide education and guidance for healthcare organizations to strengthen documentation, coding compliance, and audit preparedness.
- Advocate for a healthcare system that puts patients and integrity first.
Compliance must be more than an afterthought. In a climate where corporate influence can bend policy, ethical leadership becomes a competitive and moral necessity. Medscholaria is ready to meet that need, helping organizations navigate the complexities of UM, coding, and federal audits without sacrificing their commitment to ethical patient care.
California’s Medical Parole Reversal: Ethical Leadership in Crisis
On the state level, another major development captured headlines and sparked outrage among healthcare advocates: California’s decision in April 2025 to abruptly halt its medical parole program, resulting in critically ill inmates being sent back to prisons.
This move was not only controversial — it directly violated previous court orders. Medical parole laws, designed to provide compassionate early release to terminally or severely ill prisoners, have been a fixture of California law for over a decade. By reversing course, the state reintroduced profound ethical, legal, and public health concerns.
The effects are devastating:
- Correctional healthcare systems are now burdened with managing complex, resource-intensive cases in facilities ill-equipped for such demands.
- Severely ill inmates, who should have received compassionate release and appropriate care, now face suffering and preventable deterioration.
- California taxpayers may end up bearing higher healthcare costs due to the intensive care needs of these individuals within the prison system.
- The broader public must reckon with the erosion of progressive justice reforms, and the moral question of how we treat our most vulnerable citizens.
For healthcare consulting, and particularly for Medscholaria, this issue is not peripheral. It lies squarely within our mission.
We are preparing to offer consulting services that will help correctional health systems:
- Develop ethical utilization management policies that balance patient care needs, legal obligations, and cost-effectiveness.
- Strengthen compliance with federal, state, and accreditation standards for correctional healthcare.
- Support public health strategies that recognize compassionate care as a core component of community wellness and justice reform.
Healthcare in the correctional setting is an area where ethical lapses have profound consequences — not just for inmates, but for public health at large. Medscholaria is committed to helping correctional institutions build healthcare policies and systems that uphold both legal mandates and human dignity.
The Bigger Picture: Advocacy Through Action
Both the Medicare Advantage and California medical parole cases reflect a disturbing but critical truth: healthcare policy and practice are deeply vulnerable to political, financial, and systemic pressures.
If left unchecked, these forces can undermine the very foundations of public health, ethics, and trust.
At Medscholaria Consulting, we refuse to accept that status quo. Instead, we are building a consulting practice centered on three principles:
- Compliance with Integrity: Ensuring that healthcare organizations meet regulatory standards not by cutting corners, but by strengthening their operations and protecting patient welfare.
- Ethical Utilization Management: Supporting organizations in making resource allocation decisions that are both financially sound and morally defensible.
- Strategic Education and Leadership Development: Empowering healthcare administrators, case managers, UM teams, and correctional health leaders to lead reform from within through education and policy alignment.
As I complete advanced coursework and my Certified Professional in Healthcare Quality (CPHQ) certification, Medscholaria will continue to expand its capabilities — offering continuing education courses, custom consulting solutions, and policy advisory services across sectors.
Because real change does not come from talking about ethics — it comes from operationalizing ethics into compliance, into audits, into utilization management, and into leadership.
Conclusion: Shaping the Future of Healthcare Compliance
The problems exposed by the Medicare Advantage influence machine and California’s medical parole reversal are systemic — but they are also solvable. With the right strategies, ethical leadership, and policy alignment, healthcare organizations can do more than survive audits or legislative shifts. They can lead the transformation toward a healthcare system that balances financial realities with a profound commitment to public trust and patient dignity.
At Medscholaria Consulting, we are proud to be part of that transformation.
And we are just getting started. Check out our course page for future CE offerings
References
Schulte, F., & Hacker, H. K. (2024, September 30). The Medicare Advantage Influence Machine. KFF Health News. Read Here
Thompson, D. (2025, April 21). California Halts Medical Parole, Sends Several Critically Ill Patients Back to Prison. KFF Health News. Read Here