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Healthcare developments · Sep 20, 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 20, 2026 editionRead story →

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Audits & program integrityMedicare & MedicaidContinuing

CMS reports $1.6 billion in Medicare laboratory program integrity actions across revocations, suspensions, recoupments and referrals

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 →

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