Enforcement Briefing · Sep 6, 2026

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Billing fraud & false claimsEnforcement BriefingContinuing

The Villages Health System agrees to a $541.5 million settlement over invalid Medicare Advantage diagnosis codes after self disclosing

A $541.5 million settlement addresses allegedly unsupported Medicare Advantage diagnoses and chart amendments at The Villages Health System. DOJ credited self-disclosure and cooperation. Bankruptcy approval and the plans’ separate repayment responses are part of the resolution; liability was not determined.

High priority · Sep 6, 2026 editionRead story →

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Consumer & business misconductEnforcement BriefingNew in this edition

Florida DME operators sentenced in $34.8 million brace fraud scheme

Two Florida DME operators received prison sentences after guilty pleas in a $34.8 million brace-fraud scheme that used paid false orders and shifted billing among related suppliers.

Medium priority · Sep 6, 2026 editionRead story →

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Drugs & prescribingEnforcement BriefingNew in this edition

Med spa owner sentenced for counterfeit injections

Rebecca Fadanelli received a 46-month sentence for counterfeit injections, with separate restitution and forfeiture orders of $1,001,562 each.

Medium priority · Sep 6, 2026 editionRead story →

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Billing fraud & false claimsEnforcement BriefingNew in this edition

Heuser Health settles skin-substitute overbilling allegations

Heuser Health agreed to pay $2,646,186.72 over allegations that skin-substitute claims overstated actual invoice costs.

Medium priority · Sep 6, 2026 editionRead story →

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Billing fraud & false claimsEnforcement BriefingContinuing

Monogram Health agrees to $2.4 million settlement over Medicare Advantage diagnosis codes

Monogram’s $2.4 million resolution concerns four diagnosis categories submitted under in-home Medicare Advantage risk-sharing arrangements. DOJ describes clinical accuracy, documentation and relevance to care during 2021–2023, credits cooperation and provides a whistleblower share. The allegations were not adjudicated.

Medium priority · Sep 6, 2026 editionRead story →

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Enforcement Briefing · Sep 6, 2026

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