Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
Updated Fri 12:06 PM MT
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Informational use only. Not legal or compliance advice.
Sunday, October 4, 20260 Stories Today
Legal·WA·2d ago

Judge Lets Some Immigrants Keep Washington Medicaid Coverage

A federal provision in the 2025 tax and spending law stripped Medicaid eligibility for refugees, asylees, trafficking survivors, and other lawfully present immigrants nationwide, cutting roughly 10,000 people in Washington from coverage as of Thursday. A U.S. District Court judge in Seattle issued a preliminary ruling preserving coverage for an estimated 800 of those immigrants who receive Supplemental Security Income, finding federal officials improperly tried to override existing eligibility rules; the government may appeal. State officials separately updated immigration records to save coverage for about 3,000 more people, reducing original loss projections from 14,000. Washington's governor has issued an executive order to track coverage losses and explore state funding options, while advocates push for state dollars to cover the gap.

Legal·1d ago

Independence Blue Cross Pays $22.5M to Settle MA Fraud Claims

Independence Blue Cross agreed to pay $22.5 million to resolve allegations that it inflated diagnosis codes for Medicare Advantage beneficiaries to boost risk-adjustment payments. The insurer described the settlement, along with similar resolutions by other payers, as reflecting "industry-wide challenges" in applying Medicare Advantage risk adjustment standards. The matter concerns Medicare Advantage rather than Medicaid managed care directly, though risk adjustment practices and enforcement scrutiny often extend across both program types for payers operating in both markets.

Legal·AZ·1d ago

Arizona AG Sues Express Scripts, Optum Over Opioid Role

Arizona Attorney General Kris Mayes filed a consumer fraud lawsuit Oct. 1 against pharmacy benefit managers Express Scripts and Optum, alleging their formulary and rebate practices fueled the state's opioid epidemic over more than two decades. The complaint alleges the PBMs gave OxyContin unrestricted preferred formulary status in exchange for confidential payments from Purdue Pharma, avoided prior authorization and step-therapy controls, distributed misleading materials downplaying addiction risk, and sold prescriber data for targeted opioid marketing. Filed under the Arizona Consumer Fraud Act, the suit seeks restitution, civil penalties, injunctive relief, disgorgement and corrective programs. It closely mirrors a similar Arkansas lawsuit filed against the same two PBMs in June 2024, part of a broader wave of state litigation scrutinizing PBM business practices.

4 state intelligence items published yesterday across 3 states. Legislation, agency updates, SPAs, waivers, procurements. Track yours with a Pro watchlist.

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Legal·SC·1d ago·oig.hhs.govOIG Finds SC Underreported $108.6M in Medicaid COVID FMAP CollectionsLegal·WI·1d ago·oig.hhs.govOIG Finds Wisconsin May Have Misclaimed $455M in School Medicaid FundsLegal·2d ago·Becker'sOracle Health Breach Now Affects 29 Hospital SystemsLegal·2d ago·Becker'sDOJ Memo Prioritizes Healthcare Fraud in Corporate InvestigationsLegal·IA·2d ago·iowacapitaldispatch.comIowa Attorney Sentenced for Rolls Royce Medicaid Eligibility Fraud SchemeLegal·2d ago·opb.org+1 moreCourt Strips Integration Mandate From Section 504 RulesLegal·3d ago·jdsupra.comLaw Firm Assesses Six Months of CMS Home Health Enrollment MoratoriumLegal·WI·3d ago·wisconsinwatch.orgJudge Strikes Down Trump Rule Requiring Immigration Checks for Federal ServicesLegal·IA·3d ago·iowacapitaldispatch.comFormer Public Defender Sentenced for Medicaid Fraud SchemeLegal·FL·3d ago·floridaphoenix.comFlorida House Democrats Ask IRS to Probe Hope Florida FundsLegal·MA·3d ago·skillednursingnews.comRegalCare Nursing Home Execs Pay $1M Over Billing ClaimsLegal·MA·3d ago·bhbusiness.comAutism Provider Sues Massachusetts to Block MassHealth RecoupmentLegal·NY·3d ago·jdsupra.comHHS-OIG Denies Recertification of New York's Medicaid Fraud UnitLegal·CO·4d ago·Colorado NewslineCWS Colorado Director Urges Congress Restore Refugee Medicaid EligibilityLegal·NC·4d ago·wral.comWhistleblowers Allege NC Officials Falsified Medicaid Tech Funding BidsLegal·MD·5d ago·Becker'sUMMS Settles With Maryland AG Over Facility Fee BillingLegal·5d ago·Becker'sUnitedHealthcare, TeamHealth Settle $100M Upcoding LawsuitLegal·5d ago·jdsupra.comBaker Donelson Flags 2026 Medicare Fraud Enforcement Surge for ProvidersLegal·5d ago·jdsupra.comDOJ Revises Justice Manual on FCA Guidance Use, Qui Tam DismissalsLegal·GA·5d ago·oig.hhs.govOIG Reviews Georgia Medicaid Fraud Control Unit's 2024 OperationsLegal·5d ago·KFF ResearchBrief Details Medicaid Fraud Control Units' Caseload and OutcomesLegal·8d ago·Becker'sLabcorp Settles Multistate Data Breach Investigation for $2.28 MillionLegal·TN·8d ago·tennesseelookout.comPlanned Parenthood Sues Tennessee AG Over Investigation Demanding Patient Records, Donor DetailsLegal·8d ago·FoleyWarren, Wyden Introduce Bill to Ban Corporate Practice of Medicine NationwideLegal·8d ago·jdsupra.comDOJ and State MFCU Enforcement Rises in Applied Behavior Analysis BillingLegal·TN·8d ago·oig.hhs.govOIG Finds Tennessee Improperly Claimed Millions in Federal Medicaid Reimbursement for Targeted Case ManagementLegal·IA·9d ago·iowacapitaldispatch.comIowa Medicaid Fraud Elimination Task Force Defers Staffing RecommendationsLegal·MO·9d ago·missouriindependent.comMissouri Medicaid Enrollee Sues Over Trump Administration Work Requirement Exemption RuleLegal·10d ago·Becker'sDOJ Revises False Claims Act Manual to Clarify Enforcement StandardsLegal·FL·10d ago·Becker'sFlorida Sues Insulin Manufacturers and PBMs Over Alleged Price Inflation SchemeLegal·NY·10d ago·oig.hhs.govOIG Finds New York Made Unallowable Capitation Payments for Incarcerated EnrolleesLegal·TX·11d ago·Healthcare DiveTexas Hospitals Sue Independence Blue Cross Over Denied Claims Under BlueCard ProgramLegal·CT·11d ago·oig.hhs.govOIG Finds Connecticut DDS Failed to Monitor HCBS Waiver Compliance for Home Support ServicesLegal·12d ago·FoleyDOJ Revises Justice Manual to Strengthen False Claims Act EnforcementLegal·12d ago·jdsupra.comFinCEN Flags $17.5B in Suspected Health Care Fraud Across Medicare and MedicaidLegal·NC·12d ago·wral.comAbbott Pays $384M to Settle Medicaid Fraud Claims Over 2022 Formula ContaminationLegal·12d ago·stateline.org+4 moreMedical Groups and Enrollees Sue Over Federal Medicaid Work RequirementsLegal·12d ago·Becker'sNYU Langone, UPMC Settle DOJ Gender-Affirming Care Cases for $9.45MLegal·13d ago·stateline.org+2 moreFederal Judge Dismisses Challenge to Title X Grant Process ChangesLegal·VT·16d ago·vtdigger.orgVermont Provider Settles Medicaid Fraud Allegations for $390,000Legal·16d ago·Healthcare DiveOIG Finds Humana and UnitedHealth MA Plans Generated $180M in Upcoding OverpaymentsLegal·16d ago·jdsupra.comCMS Affiliation Rule Enables 10-Year Medicare Enrollment Bars for Physicians Without Direct ViolationsLegal·NC·16d ago·oig.hhs.govOIG Finds North Carolina Medicaid Fraud Control Unit Compliant in 2025 InspectionLegal·TX·17d ago·The HillTexas Family Sues Attorney General Paxton Over Denied Abortion Leading to Maternal DeathLegal·AR·17d ago·Healthcare DiveArkansas Pharmacies File First Lawsuit Against Express Scripts Under State PBM Payment LawLegal·17d ago·FoleyDOL Warns Plans to Maintain Mental Health Parity Compliance Despite Non-Enforcement PostureLegal·18d ago·Home Health Care NewsHome-Based Care Providers Face Heightened Medicaid Program Integrity Oversight Amid AI Adoption
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Medicaid Monitor is an informational resource operated by Lanphier Ventures, LLC. Content is curated and summarized using AI and is provided for general informational purposes only. It does not constitute legal, regulatory, or compliance advice.

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