Enforcement Briefing · Oct 4, 2026

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Billing fraud & false claimsEnforcement BriefingNew in this edition

Independence Blue Cross settles MA diagnosis-retention allegations for $22.5 million

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.

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Billing fraud & false claimsEnforcement BriefingNew in this edition

Signal Diagnostics resolves uninsured-program overpayment allegations for $20.5 million

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.

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Drugs & prescribingEnforcement BriefingNew in this edition

Done prescriber convicted in stimulant distribution conspiracy

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.

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Billing fraud & false claimsEnforcement BriefingNew in this edition

Adult day-care owner pleads guilty in $65 million Medicaid scheme

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.

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Patient safety & protectionEnforcement BriefingContinuing

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Enforcement Briefing · Oct 4, 2026

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