The complete edition, organized by topic. Every published finding remains available.
Archived edition. This edition reflects its original coverage dates and may not reflect current requirements. Read the latest edition →
56 articles: 38 new or updated, 11 continuing, 7 closed.
All articles are listed below, including continuing and closed findings. The approved report also includes horizons, trends and implementation material.
56 articles shown, grouped by category.
Active high- and medium-priority findings, organized by topic.
RegalCare entities and two executives agreed to $1 million plus interest, with specific admitted billing facts; the signed agreement qualifies how clinical consultation and MDS certification occurred.
High priority · Oct 4, 2026 editionRead story →
Independence Blue Cross agreed to pay $22.5 million over alleged retention of Medicare Advantage overpayments. DOJ says chart reviews added diagnoses while leaving unsupported diagnoses uncorrected. The settlement resolves allegations without a determination of liability.
High priority · Oct 4, 2026 editionRead story →
Signal Diagnostics agreed to pay $20.5 million over alleged retention of HRSA COVID-19 Uninsured Program payments for insured patients. DOJ describes conflicting insurance records and an internal audit that identified ineligible claims without the required refunds. Liability was not determined.
High priority · Oct 4, 2026 editionRead story →
Ahsan Ijaz pleaded guilty to a conspiracy involving approximately $65 million in New York Medicaid claims for unprovided adult day-care and home-care services. DOJ describes enrollment kickbacks and billing while beneficiaries were outside the country. Sentencing was still pending.
High priority · Oct 4, 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 · Oct 4, 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 · Oct 4, 2026 editionRead story →
Crown Medical Solutions and its owners agreed to $825,000 based on ability to pay, resolving disputed Medicare DME claims without a liability determination.
Medium priority · Oct 4, 2026 editionRead story →
California announced a guilty plea and two-year prison sentence in a $413,643.30 IHSS and respite-care fraud case involving false claims about a disabled family member's care.
Medium priority · Oct 4, 2026 editionRead story →
Missouri reported Melissa Bates's false personal-care clocking scheme and a suspended imposition of sentence with five years' unsupervised probation, plus financial obligations.
Medium priority · Oct 4, 2026 editionRead story →
Two Pristine Health operators pleaded guilty to wire fraud involving unprovided housing-support services; DOJ distinguishes more than $500,000 defrauded from over $820,000 billed.
Medium priority · Oct 4, 2026 editionRead story →
A September 17 DME indictment and September 29 arrest concern alleged shell suppliers, stolen beneficiary and physician identities and shifting Medicare claims; charges remain unproven.
Medium priority · Oct 4, 2026 editionRead story →
A pending FCA suit alleges Michael Neret billed nearly $500,000 for surgical neurostimulator implants while staff instead applied inexpensive electro-acupuncture devices in office sessions.
Medium priority · Oct 4, 2026 editionRead story →
New York charged dentist Suleman Nasimi and Tooth Fresh Meadows over allegedly unperformed Medicaid procedures, including claims during overseas travel; the charges are unproven.
Medium priority · Oct 4, 2026 editionRead story →
White Oak Manor of Burlington agreed to $98,474 over disputed Medicaid claims involving an unlicensed nurse, including $49,237 in restitution; liability was not admitted or judicially determined.
Medium priority · Oct 4, 2026 editionRead story →
Tekiyah McLeod admitted billing Medicaid for nonexistent therapy and using a nurse practitioner's identity without consent; sentencing was scheduled for December 16.
Medium priority · Oct 4, 2026 editionRead story →
An October 2 jury verdict convicted Done prescriber Jonathan Decker of a controlled-substance conspiracy and six distribution counts. DOJ describes more than two million stimulant pills, prescribing without adequate examination and ignored patient-safety warnings. The statutory maximum is not an imposed sentence.
High priority · Oct 4, 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 · Oct 4, 2026 editionRead story →
Four participants received imposed sentences in an Annandale prescribing conspiracy involving false patient identities, paid prescriptions and multi-state pickups.
Medium priority · Oct 4, 2026 editionRead story →
Former physician Jerry Jones III received 27 months for unlawful prescribing, with cash pricing tied to doses and prescription counts and voluntary license surrender reported.
Medium priority · Oct 4, 2026 editionRead story →
Federal charges allege counterfeit Ozempic distribution through unauthorized sources; Roy’s extradition and initial appearance did not resolve the criminal case.
Medium priority · Oct 4, 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 · Oct 4, 2026 editionRead story →
Fourteen September 21–25 CDPH citations remained open in the October 4 export, including patient-care, unreported-abuse and record-falsification categories.
Medium priority · Oct 4, 2026 editionRead story →
Georgia announced three neglect charges against Savannah group-home caregiver Latisha Blake-Ulmer, alleging exposure to weather and ignored injuries; guilt remains unresolved.
Medium priority · Oct 4, 2026 editionRead story →
CDPH’s October 4 export lists Bay View’s September 28 Class A patient-rights citation as open, with $3,500 assessed and outstanding.
Medium priority · Oct 4, 2026 editionRead story →
AHRQ's October 2 notice reports Hospital Rep Safety Solutions Corp.'s delisting for cause, effective September 9, after failure to correct a deficiency.
Medium priority · Oct 4, 2026 editionRead story →
Joseph Toews received 200 months in prison for producing child sexual abuse material through covert bathroom recordings at his workplace.
Medium priority · Oct 4, 2026 editionRead story →
MediExcel accepted a combined $50,000 penalty and corrective plan covering two survey matters, including grievance access, UM oversight and emergency-service denials.
Medium priority · Oct 4, 2026 editionRead story →
Adventist Health Plan accepted a $40,000 DMHC penalty after unresolved survey findings on delegated quality oversight, UM decisions and enrollee notices.
Medium priority · Oct 4, 2026 editionRead story →
Central California Alliance accepted a $2,750 DMHC penalty after a quarterly grievance report was filed 55 days late; specified corrective deliverables had already been completed.
Medium priority · Oct 4, 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 · Oct 4, 2026 editionRead story →
OIG estimated at least $24.4 million in UnitedHealthcare Texas MA overpayments from selected diagnosis codes; United disagreed with some findings and requested withdrawal of recommendations.
Medium priority · Oct 4, 2026 editionRead story →
OIG found $428,325 in unallowable kidney-transport costs and preparation or transport deficiencies at four OPOs; CMS concurred with recovery and education recommendations.
Medium priority · Oct 4, 2026 editionRead story →
OIG recommended South Carolina reconcile and refund about $108.6 million in underreported federal-share collections affected by increased COVID-19 FMAP; the state concurred with three recommendations.
Medium priority · Oct 4, 2026 editionRead story →
OIG questioned an estimated $454.9 million in Wisconsin school-based Medicaid reimbursement, separating a $67 million refund recommendation from $387.9 million to refund or substantiate.
Medium priority · Oct 4, 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 · Oct 4, 2026 editionRead story →
FTC, Utah and Nevada sued Lens.com over alleged hidden mandatory fees and AutoRefill disclosures; the case remains pending.
Medium priority · Oct 4, 2026 editionRead story →
James Campbell pleaded guilty to theft from an ERISA plan after more than $8.8 million was diverted through unauthorized withdrawals and excessive fees.
Medium priority · Oct 4, 2026 editionRead story →
Lower-priority and watch items, plus closed matters kept for the edition record.
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