The Regulator

A federal Medicaid rule that controls billions of dollars in extra payments to hospitals and nursing homes hit a new compliance deadline this week, and a much bigger cut to that same pipeline is now eight days from closing its public comment window. Starting with the first Medicaid managed care rating period on or after July 9, 2026, states must attach at least one provider-level performance metric to certain “state directed payments,” the mechanism managed care plans use to route supplemental Medicaid dollars to hospitals, nursing homes and other providers, under a Centers for Medicare and Medicaid Services (CMS) rule finalized in 2024. Separately, a CMS proposed rule published May 22, 2026 would implement the One Big Beautiful Bill Act’s new limit on those same payments, capping them at 100 percent of the Medicare rate in expansion states and 110 percent in non-expansion states, replacing today’s more generous commercial-rate ceiling; CMS itself projects the change would cut Medicaid spending by 774.8 billion dollars over ten years, 510.1 billion of it federal money and 264.4 billion state money. Comments on that proposal are due July 21, 2026. Confidence: High on the compliance date, the rate caps and CMS’s own savings projection; Medium on how individual state budgets will absorb the cut, since CMS has not published state-by-state estimates. Sources: Medicaid and CHIP Managed Care Access, Finance, and Quality Final Rule fact sheet, CMS, Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality, Federal Register, CMS Moves to Rein In Misused Medicaid Dollars and Reward Quality Care, CMS.

A Memphis gynecologist was sentenced to 20 years in prison this week for reusing medical devices on more than 15,000 procedures and billing Medicare and Medicaid 41 million dollars for it. Dr. Sanjeev Kumar, 45, was sentenced July 8, 2026 after a federal jury convicted him of 18 counts of adulterating medical devices, 16 counts of misbranding them and 6 counts of health care fraud, for routinely failing to clean and reprocess the graspers and hysteroscopes he used to perform hysteroscopy-with-biopsy procedures on Medicare and Medicaid patients between September 2019 and April 2024. Prosecutors said Kumar bought fewer than 200 new hysteroscopes and kept using single-use graspers years past their intended lifespan while billing more than 41 million dollars for the procedures, netting over 4.8 million dollars from Medicare and Medicaid alone; he received 240 months in prison plus two years of supervised release. Confidence: High. Source: Memphis Gynecologist Sentenced to 20 Years in Prison for Adulterating Medical Devices and Health Care Fraud, U.S. Attorney’s Office for the Western District of Tennessee.

Two Louisiana community-home employees were sentenced this week for abusing and filming a disabled Medicaid resident, part of a broader fraud sweep the state says has now produced 105 convictions and more than 73 million dollars in ordered restitution. Alexis Nicole George, 23, and Alexis Calvreyona Brown, 27, were sentenced July 7, 2026 for their roles in the abuse of a disabled resident at the Camellia Drive Community Home in Hammond; Brown repeatedly struck the resident while George failed to intervene, encouraged the abuse, filmed it on her phone and posted the video to Instagram instead of reporting it. Louisiana Attorney General Liz Murrill’s office announced the sentencing alongside a separate 21-arrest Medicaid fraud and abuse sweep and said it has elevated its Medicaid Fraud Control Unit, which receives roughly 10 million dollars a year in federal funding, into a standalone division within the state Department of Justice. Confidence: High. Sources: Louisiana Department of Justice press release, Office of the Attorney General of Louisiana, Two Sentenced for Abusing Disabled Resident at Hammond Community Home, WGNO.

The DEA’s hearing on whether to reschedule marijuana nationwide entered its final stretch this week, with the last opposing witnesses testifying before an expected close on July 15. Chief Administrative Law Judge Derek C. Julius recessed the hearing July 9 after witness Kenneth Finn, M.D. finished his testimony, then resumed it July 10 with the Tennessee Bureau of Investigation; pharmacist Phillip A. Drum was scheduled to testify July 13, with Nebraska, Idaho, Indiana and Louisiana state witnesses closing out the record July 14. Every party selected to testify in the proceeding opposes moving marijuana from Schedule I to Schedule III of the Controlled Substances Act, and Judge Julius faces no deadline to rule once the hearing closes. Confidence: High on the schedule; Low on timing of any ruling. Source: Marijuana Rescheduling Regulatory Actions, Drug Enforcement Administration.

The FDA approved the first anticancer drug delivered through an on-body injector this week, a change that lets multiple myeloma patients get an infusion-length treatment in about five minutes instead of an hour or more in an infusion chair. The Food and Drug Administration approved Sarclisa Escena (isatuximab-irfc), Sanofi’s subcutaneous formulation of its existing IV drug Sarclisa, on July 9, 2026, for use in combination regimens treating newly diagnosed and relapsed or refractory multiple myeloma. The approval was based on the IRAKLIA trial, which found a 71.1 percent overall response rate with the subcutaneous, on-body-injector version versus 70.5 percent with the existing intravenous version, meaning patients get comparable results while spending far less time in a chair and clinics free up infusion capacity. Confidence: High. Sources: FDA approves isatuximab-irfc for subcutaneous injection for multiple myeloma indications, U.S. Food and Drug Administration, Sanofi’s subcutaneous Sarclisa Escena approved in the US as first anticancer treatment administered via on-body injector, Sanofi.