The complete edition, organized by topic. Every published finding remains available.
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105 articles: 30 new or updated, 70 continuing, 5 closed.
All articles are listed below, including continuing and closed findings. The approved report also includes horizons, trends and implementation material.
105 articles shown, grouped by category.
Active high- and medium-priority findings, organized by topic.
AB 2448 proposed requiring specified sensitive-health-data businesses to enable security features they were already required to develop.
Medium priority · Sep 20, 2026 editionRead story →
SB 1447’s enacted surveillance timetable applies to entity reporting, with local-system and penalty safeguards.
Medium priority · Sep 20, 2026 editionRead story →
AB 1018 proposed consequential-decision AI controls with important health-sector exclusions and retained notice duties.
Medium priority · Sep 20, 2026 editionRead story →
AB 1405’s enacted AI-auditor registry begins in 2029 and applies to defined third-party state-law compliance audits.
Medium priority · Sep 20, 2026 editionRead story →
AB 1979 proposed preserving licensed clinical judgment around AI and extending CMIA treatment to defined health chatbots.
Medium priority · Sep 20, 2026 editionRead story →
AB 2575 proposed worker protections for clinical AI decisions and a limited restriction on superseding-cause defenses.
Medium priority · Sep 20, 2026 editionRead story →
CDPH’s HHA moratorium guidance separates October 9 pending-application responses from March 2027 management disclosures.
Medium priority · Sep 20, 2026 editionRead story →
AB 1760’s enacted dentistry changes include revised radiation-safety course standards and a January 2028 approval transition.
Medium priority · Sep 20, 2026 editionRead story →
AB 1199 proposed a three-year medical-staff reappointment and competency-review interval.
Medium priority · Sep 20, 2026 editionRead story →
AB 1930 proposed a protected-care legal-process notice framework with four exceptions and shorter federal-timing rules.
Medium priority · Sep 20, 2026 editionRead story →
AB 2311 permits narrowly qualified health care districts to employ physicians with medical-staff and independence safeguards.
Medium priority · Sep 20, 2026 editionRead story →
AB 2562 proposed suicide-prevention plans for licensed facilities and certified substance-use treatment programs.
Medium priority · Sep 20, 2026 editionRead story →
AB 2598 proposed documented next-of-kin contact attempts and separate public-administrator notice and penalty rules.
Medium priority · Sep 20, 2026 editionRead story →
CMS’s September 18 CAH survey guidance focuses on emergency protocols, actual use and adequate provisions.
Medium priority · Sep 20, 2026 editionRead story →
AB 1983 separates sequential-account repayments from resale-triggered continuing-care repayments.
Medium priority · Sep 20, 2026 editionRead story →
The August 28 federal IDR correction applies from August 3 and restores omitted payment-determination language.
Medium priority · Sep 20, 2026 editionRead story →
DMHC plans must report contracted PBMs by October 1 and separately ensure licensure before January 2027.
Medium priority · Sep 20, 2026 editionRead story →
AB 539 remained a proposal for longer in-network prior authorizations at the September 19 cutoff.
Medium priority · Sep 20, 2026 editionRead story →
DOJ revises FCA guidance-use and declined-qui-tam dismissal policy in its September 18 announcement.
Medium priority · Sep 20, 2026 editionRead story →
AB 2613 adds opt-in electronic delivery to affected health-plan contract-termination and restoration notices.
Medium priority · Sep 20, 2026 editionRead story →
AB 1907 changes Covered California enrollment options and application intake beginning July 2027.
Medium priority · Sep 20, 2026 editionRead story →
AB 2341 immediately changes the language calculation for local-agency emergency translations.
Medium priority · Sep 20, 2026 editionRead story →
OCR’s September 3 letter explains protected-status discrimination in HHS-funded health care and training.
Medium priority · Sep 20, 2026 editionRead story →
AB 173’s September 18 enactment changes the Medi-Cal affiliation-risk framework, subject to federal implementation conditions.
Medium priority · Sep 20, 2026 editionRead story →
SB 16 requires county designation procedures to include eligible emergency physicians without granting automatic 5150 authority.
Medium priority · Sep 20, 2026 editionRead story →
Lower-priority and watch items, plus closed matters kept for the edition record.
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Active high- and medium-priority findings, organized by topic.
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 20, 2026 editionRead story →
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 20, 2026 editionRead story →
Heuser Health agreed to pay $2,646,186.72 over allegations that skin-substitute claims overstated actual invoice costs.
Medium priority · Sep 20, 2026 editionRead story →
DOJ's pending laboratory complaint alleges $13.7 million in Medicare payments tied to mass-event genetic tests and added respiratory panels without valid individualized ordering.
Medium priority · Sep 20, 2026 editionRead story →
Rebecca Fadanelli received a 46-month sentence for counterfeit injections, with separate restitution and forfeiture orders of $1,001,562 each.
Medium priority · Sep 20, 2026 editionRead story →
Remedi SeniorCare agreed to pay more than $5.3 million over allegations of Medicare and Medicaid claims for drugs lacking valid prescriptions; payment is based on ability to pay and made over time.
Medium priority · Sep 20, 2026 editionRead story →
Four named August 26 DMHC matters total $331,000 in agreed administrative penalties. They concern distinct timely-access data, cancellation-notice, grievance-initiation and surprise-billing reporting failures. The specific records do not establish complete weekly enforcement discovery or completed payment.
Medium priority · Sep 20, 2026 editionRead story →
OIG identified hospital billing errors in Methodist and McLeod samples, recommending an estimated $12.4 million refund for Methodist and $38,676 for McLeod, with different hospital responses.
High priority · Sep 20, 2026 editionRead story →
NYU and UPMC agreed to specified pediatric service restrictions and payments totaling $9.45 million to resolve investigations; both denied allegations and no liability determination was made.
High priority · Sep 20, 2026 editionRead story →
Abbott's settlement provides approximately $385 million plus interest to resolve disputed WIC and Medicaid product-quality claims, with express denials and reserved claims.
High priority · Sep 20, 2026 editionRead story →
The $50 million resolution addresses alleged unlawful dispensing despite prescriber and prescription warning signs. A DEA agreement adds employee/patient reporting, pharmacy-pattern monitoring and suspect-prescriber review. The dated August 28 announcement reports allegations, not a determination of liability.
Medium priority · Sep 20, 2026 editionRead story →
Ten CDPH records carry August 26–27 issue dates and $73,750 in initial assessments across eight facilities. The data identify two class A citations, seven class B citations and one administrative penalty. They do not establish collections, completed appeals or a full account of the underlying incidents.
Medium priority · Sep 20, 2026 editionRead story →
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 20, 2026 editionRead story →
Lower-priority and watch items, plus closed matters kept for the edition record.
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Active high- and medium-priority findings, organized by topic.
DHCS’s August 26 notice requires quarterly validation of the public fee-for-service provider directory starting October 1. Administrators have a forty-five-day window and must save completed survey responses; missed updates affect every user’s Transaction Center access in the organization.
Medium priority · Sep 20, 2026 editionRead story →
OIG separates an estimated $380 million organ-counting policy conflict from $154,210 in specifically unsupported reimbursement. The findings call for different policy and documentation responses.
Medium priority · Sep 20, 2026 editionRead story →
Medi-Cal’s September 1 hospice notice separates the five-calendar-day portal attestation from the signed election form, which stays in the member’s medical record.
Medium priority · Sep 20, 2026 editionRead story →
Pending AB 2499 would require standard electronic supporting-document submission from May 26, 2028, including receipt confirmation and protections against system-only claim delays.
Medium priority · Sep 20, 2026 editionRead story →
Pending AB 2571 would expand pharmacist payment routes and advanced-practitioner reimbursement, with distinct commercial, Medi-Cal and FQHC/RHC conditions.
Medium priority · Sep 20, 2026 editionRead story →
CMS reports applications from every state, DC and Puerto Rico, but fewer signed GENEROUS agreements. The September 30 signing date remains ahead; applications alone do not establish each state’s participation terms.
Medium priority · Sep 20, 2026 editionRead story →
AB 1126 limits excess Medi-Cal billing barriers after other coverage, with a Medicare exception and federal implementation conditions.
Medium priority · Sep 20, 2026 editionRead story →
DHCS’s September stakeholder notice prepares a January 1 managed-care-to-fee-for-service transition for specified members. It points to readiness meetings and member and provider resources.
Medium priority · Sep 20, 2026 editionRead story →
Noridian’s August 27 notices finalize two MolDX policies for October 12 and retire the older thrombophilia policy October 11. Coverage remains conditional on each policy’s clinical and testing criteria; a test’s name alone does not establish coverage.
Medium priority · Sep 20, 2026 editionRead story →
Pending AB 280 proposes a central provider-directory utility, common standards and reasonable-reliance protections, with specific integrated-plan and Medi-Cal scope exceptions.
Medium priority · Sep 20, 2026 editionRead story →
Pending AB 350 addresses medically necessary fluoride varnish across medical and dental billing and proposes Medi-Cal guidance for members under twenty-one, with training and federal conditions.
Medium priority · Sep 20, 2026 editionRead story →
Pending AB 1682 would cover prescribed FDA-cleared scalp cooling for chemotherapy-related hair loss in large-group coverage and conditionally in Medi-Cal.
Medium priority · Sep 20, 2026 editionRead story →
Pending AB 1876 would strengthen plan and insurer nondiscrimination provisions and grievance notices while preserving legitimate, nondiscriminatory clinical and coverage decisions.
Medium priority · Sep 20, 2026 editionRead story →
Noridian’s September 17 JE notices set a nerve-policy transition and separate facet-joint coding and MolDX hyperlink revisions.
Medium priority · Sep 20, 2026 editionRead story →
OIG attributes $587.7 million in ineligible Part D payments to obsolete prescription labeling and oversight gaps. The audit recommends a sponsor-rejection timeframe; it does not itself impose a universal new cutoff.
Medium priority · Sep 20, 2026 editionRead story →
California’s September 2 lawsuit challenges October 13 Medicaid and CHIP reimbursement restrictions. The filing seeks relief; it does not itself suspend the rule or establish a later court outcome.
Medium priority · Sep 20, 2026 editionRead story →
Pending AB 220 would limit extra pediatric subacute criteria and duplicate authorization forms, with specific protections for return from an acute-hospital bed hold.
Medium priority · Sep 20, 2026 editionRead story →
CMS is proposing an annual hospital-at-home services collection, with comments due October 26. The new CMS-10971 tool would describe clinician visits, food and pharmacy services; the notice seeks OMB approval and does not itself establish an approved reporting start date.
Medium priority · Sep 20, 2026 editionRead story →
CMS announced spring 2027 ACCESS expansion for additional chronic conditions under voluntary Original Medicare participation.
Medium priority · Sep 20, 2026 editionRead story →
The September 18 EDI transmittal replaces the August version to correct two 276/277 spreadsheet errors; systems implementation remains October 5.
Medium priority · Sep 20, 2026 editionRead story →
CMS published the final 2027 mandatory Ambulatory Specialty Model participant list and highlighted reporting and attestation duties.
Medium priority · Sep 20, 2026 editionRead story →
CMS’s September 11 instructions align FY 2027 inpatient rates, Grouper/MCE 44.0, Pricers and provider files with October 1 discharges and October 5 implementation.
Medium priority · Sep 20, 2026 editionRead story →
DHCS’s ACWDL 26-16 restores January 2027 asset tests for specified groups with application, renewal, cure and transfer-review protections.
Medium priority · Sep 20, 2026 editionRead story →
CMS’s August 28 laboratory announcement combines projected savings, suspended payments, recoupments and referral-related prevention. Its examples describe rapid billing intervention, but the headline total is not a single recovered sum or an adjudication that every associated claim was fraudulent.
High priority · Sep 20, 2026 editionRead story →
Lower-priority and watch items, plus closed matters kept for the edition record.
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