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Enforcement Briefing · Oct 11, 2026

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Consumer & business misconductEnforcement BriefingNew in this edition

AIDS Healthcare Foundation settlement highlights delayed diagnosis deletions

A Medicare Advantage settlement concerns diagnosis codes left unresolved after internal reviewers questioned their support. DOJ describes delayed investigation and deletion, while expressly retaining the allegations-only status of the resolved claims.

High priority · Oct 11, 2026 editionRead story →

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Consumer & business misconductEnforcement BriefingContinuing

NYU and UPMC agree to end specified pediatric services and pay $9.45 million to resolve federal investigations

NYU and UPMC agreed to stop specified pediatric services and pay a combined $9.45 million to resolve federal investigations. The agreements are entity-specific resolutions of disputed allegations, with cooperation credit and no determination of liability.

High priority · Oct 11, 2026 editionRead story →

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Consumer & business misconductEnforcement BriefingContinuing

Abbott agrees to pay about $385 million over alleged WIC and Medicaid product-quality misrepresentations

Abbott’s roughly $385 million settlement resolves disputed government-payment claims tied to formula manufacturing and quality representations. The agreement separates federal, state Medicaid and Massachusetts WIC amounts, conditions releases on payment, and reserves several other categories of claims.

High priority · Oct 11, 2026 editionRead story →

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Audits & repaymentsEnforcement BriefingContinuing

OIG hospital audits identify Medicare overpayments and recurring claim-control failures

Separate OIG hospital audits identified $256,926 in sampled Methodist overpayments, with an estimated $12.4 million for selected services, and $38,676 at McLeod. The reports distinguish disputed recommendations and agreed refunds from a judgment or confirmed recovery.

High priority · Oct 11, 2026 editionRead story →

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Billing fraud & false claimsEnforcement BriefingContinuing

Skilled-nursing company and executives agree to $1 million therapy overbilling settlement

RegalCare and two executives agreed to a $1 million settlement that includes admitted facts about unsupported therapy levels and premature billing. The primary agreement distinguishes clinical consultation, assessment changes and RN certification, making patient-specific accuracy and finalized documentation central to the control lesson.

High priority · Oct 11, 2026 editionRead story →

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