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Monday, August 10 · 3 stories
- Legal
Senate HELP Committee Presses DOJ on Steward CEO Contempt Referral
The Senate HELP Committee sent a letter August 6, 2026, to Acting Attorney General Todd Blanche requesting an update on the criminal contempt referral against former Steward Health Care CEO Ralph de la Torre. The committee, led by Chairman Sen. Bill Cassidy (R-La.), seeks information on DOJ action following Dr. de la Torre's failure to comply with congressional testimony requirements. The referral stems from ongoing congressional oversight of Steward's bankruptcy and operations. This follows the committee's investigation into Steward's financial practices and facility closures affecting patient access.
Friday, August 7 · 1 story
- Legal · ME
Maine Suspends Medicaid Payments to Five Providers on Fraud Allegations
Maine announced payment suspensions for five Medicaid providers based on fraud allegations, including Portland-based Gateway Community Services. The action follows months of Republican criticism that the Mills administration had inadequately addressed Medicaid fraud. The suspensions represent credible allegations of fraud triggering payment holds under federal Medicaid program integrity requirements. Maine did not disclose the specific nature of the fraud allegations or the total payment amounts suspended.
Wednesday, August 5 · 5 stories
- Legal
Federal Courts Rule Hospices Deserve Deference on Six-Month Life Expectancy Determinations
Federal courts have issued several rulings favoring hospices in administrative appeals, particularly recognizing that hospices should receive deference when determining six-month life expectancy for patient eligibility. These rulings counter administrative law judge decisions that had reversed hospice eligibility determinations. The court decisions affect how hospices defend Medicare and Medicaid eligibility claims during audits and appeals. This development matters for hospices serving dual-eligible beneficiaries and state Medicaid programs that follow Medicare hospice coverage rules.
- Legal
District Court Requests Feasibility Briefing After Columbus II Oral Argument on 2027 NBPP Rule
Following July 8 oral argument in City of Columbus v. Kennedy, challenging CMS's 2027 Notice of Benefit and Payment Parameters Final Rule, the U.S. District Court for the District of Maryland ordered supplemental briefs on implementation feasibility. The Court asked parties to address whether relief could be granted without disrupting the 2027 Marketplace plan year and whether staying catastrophic-plan guidance would affect enrollees. The case involves provisions of the NBPP final rule affecting Exchange operations. Supplemental briefing timing will determine how quickly the Court rules and whether any injunction could affect 2027 plan year implementation.
- Legal · PA
DOJ Launches Philadelphia Medicaid Fraud Strike Force
The Department of Justice announced on August 4, 2026, the creation of a dedicated Medicaid fraud strike force in Philadelphia, expanding its Northeast Health Care Fraud Strike Force operations. The new unit will focus on investigating and prosecuting Medicaid fraud cases in the Philadelphia region. The announcement coincides with a parallel expansion of DOJ's West Coast Strike Force, signaling intensified federal enforcement activity targeting Medicaid program integrity. The move indicates heightened scrutiny of Medicaid providers, plans, and related entities operating in these regions.
- Legal · PA
DOJ Charges 19 Defendants in $4M Medicare and Medicaid Home Health Fraud Scheme
The Department of Justice, in coordination with the U.S. Attorney's Office and Pennsylvania Attorney General, charged 19 defendants in a $4 million Medicare and Medicaid fraud scheme involving home health services. The alleged scheme included billing for services never rendered and submitting claims for unrealistic service hours. The charges were announced in early August 2026. The enforcement action signals continued federal and state scrutiny of home health billing practices, particularly phantom billing and time-based service inflation.
- Legal · ME
Maine Supreme Court Upholds $750M Medicaid Transport Contract with Modivcare
The Maine Supreme Court ruled Tuesday in favor of the state's 10-year, $750 million Medicaid non-emergency transportation contract with Denver-based Modivcare, ending a legal challenge by nonprofit provider Penquis. The decision allows Maine DHHS to proceed with the statewide contract, consolidating NEMT services under a single vendor. The ruling resolves a multi-year procurement dispute and establishes the operational framework for Medicaid transportation services statewide. The contract represents one of the largest NEMT procurements nationally and affects transportation access for Maine's Medicaid beneficiaries.
Tuesday, August 4 · 1 story
- Legal
HRC Sues Trump Administration Over Gender-Affirming Care Coverage Ban in Federal Employee Health Plans
The Human Rights Campaign filed a class-action lawsuit Monday challenging the Trump administration's ban on gender transition treatment coverage in federal employee health plans. The suit alleges the coverage ban violates federal sex discrimination protections in employment. The lawsuit does not directly target Medicaid or CHIP programs, though similar coverage restrictions could inform future Medicaid policy debates. The case centers on Federal Employees Health Benefits Program coverage, not state Medicaid programs.
Monday, August 3 · 1 story
- Legal · IA
Former Iowa Agency Directors Criticize Attorney General's New Medicaid Fraud Task Force
Two former directors of Iowa's Department of Inspections and Appeals publicly criticized Attorney General Brenna Bird's newly created Medicaid fraud task force, calling it political theater. Dean Lerner and Kevin Techau, who led the agency under previous Democratic governors, questioned the legitimacy and operational purpose of the task force announced Friday. The criticism comes as Bird, a Republican, establishes what she characterizes as enhanced fraud enforcement efforts. The statement represents rare public pushback from former state officials with direct program integrity experience.
Friday, July 31 · 2 stories
- Legal · MI
Michigan AG Alleges Medicaid Fraud by Nursing Home Chain for Substandard Care
Michigan Attorney General Dana Nessel announced allegations that Pioneer Health Care (doing business as Legacy Health Care Management) fraudulently billed Medicaid for millions while failing to provide adequate staffing and care to nursing home residents. The announcement was made on July 30, 2026, though specific charges or penalty amounts have not yet been detailed. The case affects Michigan Medicaid expenditures on long-term care facility services and signals heightened state enforcement on quality-linked billing practices in nursing homes.
- Legal
DOJ Abandons Longstanding Olmstead Enforcement Guidance Affecting HCBS Programs
The Department of Justice announced last week it will no longer rely on its longstanding guidance interpreting Olmstead v. L.C., the landmark ADA case requiring states to provide community-based services to individuals with disabilities rather than institutional care. The shift represents a major change in how DOJ enforces disability rights protections that underpin state Medicaid home and community-based services programs. The policy change takes effect immediately. This matters because DOJ enforcement has historically pressured states to expand HCBS capacity and reduce institutional placements — a retreat from that enforcement posture could affect state investment decisions, HCBS waiver design, and provider networks built around community integration mandates.
Thursday, July 30 · 2 stories
- Legal
Federal Judge Denies States' Motion to Postpone Medicaid Work Requirements
A federal judge denied a motion from 26 states seeking to delay implementation of Medicaid work requirements announced by CMS in June. The ruling means the work requirements will proceed as scheduled, absent further legal action. The decision affects states that had challenged the timeline for implementing the requirements, which would condition Medicaid eligibility on meeting work or community engagement standards. The ruling has immediate implications for state Medicaid agencies preparing operational and system changes to comply with the federal policy.
- Legal
Texas District Court Vacates CMS Rule Excluding 1115 Waiver Days from DSH Calculations
On July 27, 2026, the U.S. District Court for the Northern District of Texas vacated a 2023 CMS regulation that excluded inpatient days covered by Section 1115 waiver uncompensated care funding pools from Medicaid disproportionate share hospital (DSH) day counts. This is the second time the court has struck down this rule in Covenant Medical Center v. Kennedy. The ruling affects how hospitals calculate their Medicaid patient volume for DSH payment eligibility. The decision takes effect immediately, allowing hospitals to include these waiver days in their DSH calculations until CMS takes further action.
Wednesday, July 29 · 1 story
- Legal
Hospice Fraud Scrutiny Raises Concerns About Patient Access and Regulatory Overreach
Health policy researchers and hospice providers warn that heightened fraud enforcement and negative attention on the hospice industry could lead to overly restrictive regulations that limit patient access to end-of-life care. The concerns emerge as federal enforcement actions against fraudulent hospice operators have intensified. While stakeholders acknowledge fraud exists and requires intervention, they caution that broad-brush regulatory responses could penalize compliant providers and restrict legitimate hospice utilization. The tension reflects ongoing challenges in Medicaid and Medicare hospice program integrity.
Tuesday, July 28 · 2 stories
- Legal
D.C. Circuit Upholds CMS Authority to Retain MA Survey Data in Star Ratings
On July 14, 2026, the D.C. Circuit Court of Appeals affirmed a district court ruling that upheld CMS's decision to retain survey data used in Medicare Advantage star ratings, rejecting Alignment Healthcare's challenge that the agency acted arbitrarily by refusing to discard the data. The decision reinforces CMS's discretion in administering the star ratings methodology and handling plan-specific data challenges. While this case involves Medicare Advantage rather than Medicaid managed care, it establishes precedent for CMS's authority over survey-based quality measurement systems that parallel those used in Medicaid managed care quality rating systems in multiple states.
- Legal · NC
North Carolina Monitor Flags HCA for Potential Breach of Mission Hospital Sale Agreement
Dogwood Health Trust, the independent monitor overseeing HCA Healthcare's 2019 acquisition of Mission Hospital in North Carolina, notified the state attorney general that HCA may be in noncompliance with the sale contract. The two potential violations involve a federal warning in October 2025 that Mission risked losing Medicaid and Medicare participation status, and a second undisclosed issue. The monitor's role is to enforce conditions negotiated when HCA purchased the hospital, which serves as a critical safety-net provider in western North Carolina. The attorney general's office will determine whether enforcement action is warranted.
Monday, July 27 · 3 stories
- Legal
CVS Moves to Dismiss Hospital Lawsuits Over 340B Savings Diversion
CVS Health filed motions to dismiss lawsuits brought by hospital systems in New York and Michigan alleging the company diverted 340B Drug Pricing Program savings. In a July 22 filing in the Eastern District of Michigan, CVS argued that University of Michigan Hospitals and Health Centers' lawsuit is a contract dispute rather than a 340B policy matter. The lawsuits center on allegations that CVS improperly retained savings intended for 340B-covered entities. The outcome could affect how pharmacy benefit managers handle 340B claims and reimbursements for safety-net providers, including Medicaid Disproportionate Share Hospitals.
- Legal
HHS-OIG Spring 2026 Report Details Oversight of $2.4 Trillion in Federal Health Spending
The HHS Office of Inspector General published its Semiannual Report to Congress covering October 1, 2025, through March 31, 2026. The report documents OIG's oversight activities across Medicare, Medicaid, and related public health programs, representing more than $2.4 trillion in annual federal health care spending. The report details enforcement actions, audit findings, and program integrity recommendations relevant to Medicaid programs and managed care plans. State Medicaid agencies and health plans should review the report for emerging enforcement priorities and compliance risks.
- Legal
HHS Appeals Ruling Vacating Portions of 2025 Marketplace Integrity Rule
HHS and CMS filed an appeal in July 2026 challenging a Maryland federal district court's June 2026 decision that vacated portions of CMS's 2025 Marketplace Integrity and Affordability Rule. The underlying case was brought by the city governments of Columbus, Baltimore, and Chicago, along with other plaintiffs. The district court ruled on summary judgment to strike down specific provisions of the rule. The appeal will determine whether those provisions remain enforceable or are permanently set aside.
Friday, July 24 · 5 stories
- Legal · NY
New York Couple Spent Down Assets Before Accessing Medicaid Long-Term Care Coverage
A New York couple exhausted their retirement savings paying for healthcare before qualifying for Medicaid coverage, reflecting broader challenges with Medicaid eligibility rules for long-term care. The story illustrates how asset spend-down requirements can delay access to Medicaid-funded long-term services and supports for aging Americans who need care but have resources above eligibility thresholds. The couple's experience highlights ongoing policy tensions around Medicaid estate recovery, asset limits, and the financial burden on families navigating the transition from private pay to Medicaid coverage.