Enforcement Briefing, week of Aug 23, 2026

DOJ announced on August 26 that The Villages Health System agreed to a $541.5 million False Claims Act settlement concerning diagnosis codes submitted to Medicare Advantage organizations during 2020 through 2024. CMS adjusts plan payments using beneficiaries’ diagnoses, and the provider’s risk-sharing arrangements could increase its own reimbursement when plan payments rose. The government alleged that codes lacked adequate medical-record support or relied on amendments not initiated by the rendering provider that were untimely or unapproved. These are the alleged coding mechanisms addressed by the settlement, not a determination that every chart amendment or risk-sharing arrangement is improper.

The resolution followed a December 27, 2024 submission under OIG’s Health Care Fraud Self-Disclosure Protocol and a July 3, 2025 Chapter 11 filing. DOJ says the bankruptcy court approved the settlement on August 25, before the announcement. It credited prompt remedial action, a detailed disclosure and cooperation. The affected Humana, UnitedHealthcare and GuideWell plans were also returning overpayments through invalid-code deletions and/or agreements with DOJ and CMS. That separates the provider’s settlement from the plans’ responses to their own CMS payments. The resolved claims remain allegations, with no determination of liability.

On August 24, DOJ announced that Monogram Health Professional Services PC and Monogram Health Inc., headquartered in Tennessee, agreed to pay $2.4 million to resolve False Claims Act allegations. Monogram provided in-home care and related services under contracts with Medicare Advantage organizations. Those risk-sharing arrangements made higher beneficiary risk scores financially relevant to both plan payments from CMS and Monogram’s reimbursement. The alleged conduct occurred from January 1, 2021 through December 31, 2023 and concerned codes that were clinically inaccurate, unsupported in the medical record and/or did not require or affect patient care, treatment or management.

The release identifies four Hierarchical Condition Categories: protein-calorie malnutrition, substance use disorder, coagulation defects and other specified hematological disorders, and angina pectoris. It explains that unsupported diagnoses can inflate risk scores and capitated payments without establishing an additional service-based entitlement. The settlement also resolves a former Monogram physician’s whistleblower action; DOJ says the relator will receive approximately $380,000 and that Monogram received cooperation credit. The announcement establishes the reported resolution, not a separately verified execution or completed-payment date. DOJ expressly states that the claims remain allegations and liability has not been determined.

OCR announced its 55th HIPAA Right of Access enforcement action on August 27, resolving a complaint involving Azul Vision, a California optometry and ophthalmology provider operating 31 clinics. The individual requested records on January 9, 2023, complained to OCR on April 27, and did not receive them until January 6, 2025. OCR identified a potential failure to provide timely access, while the agreement expressly disclaims an admission of liability. HHS’s release reports a $50,000 payment and a two-year corrective action plan. Azul signed on August 12 and HHS on August 13; the agreement becomes effective on the last signature, establishing August 13 as the resolution date rather than the later announcement.

The corrective plan requires a policy review within 30 calendar days, distribution within 60 days, and workforce training within 90 days and at least annually thereafter. It also requires recurring 90-day submissions listing access requests and response dates, annual reports, and retention of compliance records for six years. These are Azul’s negotiated duties, not automatic new reporting obligations imposed on every covered entity. The broader operational issue is whether a provider can follow a request from intake to actual delivery and detect unresolved cases before external intervention. The historical dates distinguish the underlying delay, agreement and public announcement without suggesting a new complaint or later outcome.

DEA’s August 28 announcement describes a $50 million settlement resolving allegations that Walmart pharmacies filled thousands of invalid prescriptions for opioids and other controlled substances. The government’s complaint was filed December 22, 2020 and amended in 2022; the alleged conduct began June 26, 2013. According to the release, pharmacists reported suspected pill-mill prescribers through thousands of refusal-to-fill forms, while compliance-team members and pharmacists allegedly filled invalid prescriptions despite that information. The warning signs included dangerous drug combinations, repeated high-dose prescriptions and recurring early-fill requests. These are the government’s allegations in the resolved case, not an adjudicated finding of liability.

In addition to the monetary resolution, Walmart entered a memorandum of agreement with DEA addressing future dispensing controls. The release describes a hotline for employees and patients, proactive monitoring of pharmacy dispensing patterns, and a process for evaluating prescribers suspected of illegal prescribing. Those commitments connect information gathered at individual pharmacies with corporate review and action. The settlement therefore illustrates both frontline dispensing judgment and what an organization does with warning reports it already receives. The monetary and monitoring commitments resolve allegations; the announcement does not independently document completed payment.

Four DMHC records identify August 26 administrative-penalty agreements totaling $331,000: L.A. Care matter 24-705 for $111,000, DentaQuest matter 23-768 for $150,000, Kaiser matter 24-704 for $45,000 and Community Care Health Plan matter 24-699 for $25,000. L.A. Care’s indexed record concerns timely-access reporting and methodology. Kaiser’s detailed letter describes 114 providers that remained in its measurement-year 2021 contact list despite being marked ineligible for at least three consecutive years. The Kaiser letter cites Health and Safety Code 1367.03(f)(2)/(3) and historical regulatory language under title 28 section 1300.67.2.2(g)(2)(B); it does not list every provision cited for L.A. Care. These are agreed penalties in specific matters, rather than verified receipts of payment or a complete weekly result set.

DentaQuest’s letter identifies 1,288 of 3,066 enrollees cancelled for nonpayment in 2023 who did not receive required grace-period or cancellation notices. Automated-card users received notices, while check or money-order users did not. It separately finds a failure to initiate a grievance after an enrollee complained about access and requested a refund, rather than finding that the entire grievance system lacked approval. Community Care’s indexed record addresses the number of payments to noncontracting providers at contracting facilities and related reporting data under Health and Safety Code 1371.31(a)(4), not a title 28 citation. Together, the matters illustrate how data preparation, notice generation and complaint classification can produce distinct compliance failures even when described under broad reporting categories.

Ten records in CDPH’s State Enforcement Actions export identify August 26 or 27 penalty issue dates and initial assessments totaling $73,750 across eight facilities. Professional Post Acute Center received two class A citations at $25,000 each. Seven class B citations account for $19,000: Northgate PostAcute Care, The Gardens of El Monte, two Long Beach Healthcare Center records, Astoria Healthcare Center, West Covina Healthcare Center and Able. Sierra Vista Hospital’s non-immediate-jeopardy administrative penalty is $4,750. These amounts describe the recorded initial assessments, not money collected, and the penalty issue dates are distinct from the earlier dates associated with the cited conduct.

The export records Patient Care for the two Professional Post Acute Center citations, Abuse/Facility Not Self Reported for the two Long Beach records, and other categories including Patient Rights, Physical Environment and Medication. Able’s facility type is an intermediate care facility for people with developmental disabilities; that classification does not by itself prove a habilitation-services violation. The rows provide associated legal citations and identifiers, but not the complete incident narratives. A later export’s Open disposition also cannot establish whether appeal periods had run as of this edition. The practical use is to locate the actual facility records for review while keeping assessment amounts, incident findings and procedural status separate.

On August 26, DOJ announced a False Claims Act resolution involving the former DermTech Inc., now DTech Liquidating Inc. after its June 2024 Chapter 11 filing. The United States received an Allowed Class Three General Unsecured Claim of $5,038,011 in the bankruptcy proceeding. That describes a recognized claim against the estate, not proof that the government collected the stated amount. The allegations concerned unreliable skin-cancer tests billed to Medicare and reported to patients. DOJ expressly distinguishes the bankrupt company from DermTech LLC, which purchased assets in 2024; the resolved claims do not pertain to that purchaser.

The release describes two separate testing problems. From October 2022 through March 2023, DermTech allegedly used an unvalidated positive-control range for one of two key melanoma markers. From January 2020 through February 2022, it allegedly generated positive or negative results despite insufficient patient RNA. DOJ also alleges that results were not retracted and Medicare was not adequately refunded when concerns arose. A former employee’s whistleblower action is included in the resolution; the relator is to receive 20% of the recovery actually received from bankruptcy. The payment mechanism, affected test periods and distinction between corporate entities limit what can be inferred from the headline amount. No liability determination was made.

The FTC announced on August 25 that it finalized a consent order addressing Ascension Health Alliance’s proposed $3.9 billion acquisition of AmSurg. The order requires seven ambulatory surgery center divestitures across Nashville, Panama City, Tulsa, Waco and Wichita. Six centers go to SC Affiliates and the Panama City center to Florida Gastroenterology Center. The FTC alleged harm to competition for specified gastroenterology, ophthalmology and orthopedic surgical services in those markets. The Commission’s vote was 2–0 after public comment. The final order itself was issued August 24; August 25 is the public announcement date, rather than the order’s issuance date.

Section X imposes a ten-year prior-notice duty for acquisitions of interests in ASCs performing the order-defined services in the order-defined areas. Notice must precede consummation by at least 30 days. A timely request for additional information triggers a further 30-day period after the response, subject to the order’s early-termination provision. The section excludes transactions for which the required Hart-Scott-Rodino notification has already been made. These limits are important: the obligation is neither a blanket notice rule for every ASC purchase nor a statement that every other health system has the same duty. The order also provides continuing compliance reports and restrictions on reacquiring the divested locations.