Physician and practices settle insured-patient and unperformed-test allegations
Oct 18, 2026 edition · GC-2026-0359 · Published 2026-10-18 · Version 1 · Settled
Steven Murphy and two practices agreed to pay $866,539 and accept a three-year federal-program exclusion. Allegations involved uninsured-program claims despite insurance information in patient files, and billing laboratory components that could not be performed because required reagents were unavailable.
What happened
DOJ announced October 16 that Steven Murphy, M.D., Murphy Medical Associates, LLC, and Diagnostic and Medical Specialists of Greenwich, LLC agreed to pay $866,539 to resolve federal and state False Claims Act allegations. The settlement covers September 2019 through April 2022 and includes an agreed three-year exclusion from all federal healthcare programs. The announcement does not provide the exclusion's start date. The reported conduct remains described as government allegations, rather than a criminal conviction.
The government alleged that the practices billed HRSA's COVID-19 Uninsured Program despite possessing insurance cards or other records showing coverage, and changed internal insurance identifiers to Covid19 HRSA Uninsured before submitting claims. A separate allegation concerned in-house blood-test panels: individual components were billed to Medicare or Medicaid even when the practices lacked the reagents needed to perform those tests. The case presents two distinct reconciliation failures, between source insurance records and claim attestations, and between actual laboratory performance and billed panel components.
Scope and timing
- Authority status
- Settled
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- Federal
Why it matters
An internal payer label does not establish uninsured status, and an ordered panel does not prove every component was performed. Exclusion terms also require separate operational attention beyond the monetary settlement.
Recommended action
Reconcile eligibility attestations with underlying coverage records and laboratory claims with actual test completion. Verify any relevant exclusion effective dates through authoritative records before implementing participation decisions.
Case details
- agencies
- DOJ, Connecticut Office of the Attorney General, HHS-OIG, FBI
- entities
- Steven Murphy, M.D., Murphy Medical Associates, LLC, Diagnostic and Medical Specialists of Greenwich, LLC
- action Type
- Settlement
- event Date
- 2026-10-16
- alleged Conduct
- Billing the HRSA Uninsured Program for insured patients and billing Medicare or Medicaid for laboratory components not actually performed.
- resolution
- $866,539 settlement and agreed three-year federal healthcare-program exclusion announced. Exclusion commencement and agreement execution dates not provided.
Operational lessons
- Validate eligibility attestations against original coverage evidence.
- Bill laboratory components only when performance is supported.
- Confirm exclusion effective dates separately from the announcement.
Implementation playbook
- Recommended internal target: review controls preventing internal payer overrides from bypassing insurance evidence used for program eligibility attestations. Patient Access · Due 2026-10-23
- Recommended internal target: reconcile selected billed laboratory components with completed results and reagent availability, and assess exclusion-related exposure if these entities are connected to operations. Compliance · Due 2026-10-30
Sources
- DOJ official October 16 press-release API, page 1Official · U.S. Department of Justice
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
Read the entire Enforcement Briefing report →