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Healthcare developments · Oct 4, 2026

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Medi-Cal & Medicaid policyMedicare & MedicaidNew in this edition

Medi-Cal youth gender-affirming services: October 13 reimbursement and continuity requirements

DHCS’s September 30 letter sets October 13 reimbursement limits for specified youth gender-affirming services, with an existing-hormone transition and continuing ancillary-care duties. Managed care plans must address member notices, care coordination and policy updates; the guidance does not permit blanket cancellation of care.

High priority · Oct 4, 2026 editionRead story →

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Provider operationsMedicare & MedicaidNew in this edition

Hospice election addendum is mandatory for every new election starting October 1

Every new hospice election from October 1 requires a written election-statement addendum, furnished within five calendar days. CMS also requires timely updates and a valid signed record. October–December enforcement discretion concerns claim denials for missing or incomplete addenda; it does not make the document optional.

High priority · Oct 4, 2026 editionRead story →

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Audits & program integrityMedicare & MedicaidNew in this edition

OIG finds $72 million in MA and Part D payments tied to excluded or felony-convicted providers

OIG identified $72 million in Medicare Advantage and Part D payments associated with 249 revoked NPIs absent from the Preclusion List. The brief describes timing, ownership and pharmacy-related gaps. It issues no specific recommendations and does not classify every payment as proven fraud.

High priority · Oct 4, 2026 editionRead story →

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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.

High priority · Oct 4, 2026 editionRead story →

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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.

High priority · Oct 4, 2026 editionRead story →

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