The Regulator

400 million dollars: that is what the Department of Justice agreed to pay Alaska’s largest Native-run health system this week, after the federal government spent most of a decade shortchanging it on the cost of running its own health programs. The Department of Justice announced the settlement Tuesday, July 21, 2026, resolving a 2021 lawsuit in which the Alaska Native Tribal Health Consortium alleged the Indian Health Service failed to reimburse it for contract support costs, the administrative overhead tied to money the consortium collected from Medicare and private insurers while running federally funded health programs under a self-determination compact; the consortium had sought roughly 634 million dollars covering fiscal years 2014 through 2022, excluding 2015. The settlement follows the Supreme Court’s 2024 ruling in Becerra v. San Carlos Apache Tribe, which held the government must pay contract support costs tied to third-party revenue when an agreement requires that revenue go toward a health program, precedent that gives other tribal health organizations nationwide a clearer legal basis to pursue their own unreimbursed costs. Acting Attorney General Todd Blanche said the settlement “provides the consortium with support and autonomy for the healthcare services they provide to American Indians and Alaska Natives.” Confidence: High on the settlement amount and date, corroborated across Alaska news outlets citing the Department of Justice’s own statement; Medium on the underlying dispute’s finer details, since the department’s own press release could not be independently located as of this writing. Sources: ANTHC to get $400 million settlement from feds over unpaid healthcare costs, Anchorage Daily News, Alaska Native Health Consortium secures $400M DOJ settlement, Alaska’s News Source.

45.7 million dollars: that is how much a federal audit says Colorado improperly claimed in Medicaid personal care payments that the state’s own fraud detection system should have caught. The Department of Health and Human Services Office of Inspector General posted audit A-07-24-03260 on July 21, 2026, finding Colorado did not verify that all personal care services visits were recorded in its electronic visit verification system, the tracking technology every state has been required to use since 2020 specifically to catch improper home care billing, before submitting reimbursement claims to the federal government. Of 160 sampled claims, the Office of Inspector General found enough noncompliance to recommend Colorado refund 8 million dollars in federal share immediately and coordinate with the Centers for Medicare and Medicaid Services on another 45.7 million dollars in questioned costs; the underlying audit was issued July 17, 2026. The Office of Inspector General issued six recommendations, including system edits and stronger provider monitoring, and Colorado disagreed with most of the findings. Confidence: High on the dollar figures and dates, since the Office of Inspector General’s own report confirms them; Low on how much of the questioned 45.7 million dollars the Centers for Medicare and Medicaid Services ultimately recovers, since that determination has not been made. Source: Colorado Could Improve Its Electronic Visit Verification System and Claimed Federal Medicaid Reimbursement for Millions of Dollars in Personal Care Services That Did Not Comply With Federal and State Requirements, HHS Office of Inspector General.

19.5 million dollars: that is how much a Medicare contractor improperly paid for nursing home residents’ doctor visits, therapy and wound care, getting it wrong on three claims out of every five. The Office of Inspector General posted audit A-06-21-04002 on July 20, 2026, finding Novitas Solutions, a Medicare Administrative Contractor, improperly paid approximately 19.5 million dollars for Medicare Part B evaluation and management, psychotherapy, podiatry and wound care services provided to nursing home residents; 91 of 150 sampled claims, a 60.7 percent error rate, did not meet Medicare requirements. The Office of Inspector General attributed the errors not to fraud but to providers lacking sufficient understanding of Medicare’s coding and documentation rules, and to Novitas’s own provider education and oversight falling short; Novitas concurred with recommendations to tighten oversight and add annual provider education on these four service lines. Confidence: High on the dollar figure, error rate and recommendations, since the Office of Inspector General’s own report confirms them directly. Source: Novitas Solutions, Inc., Improperly Paid Approximately $19.5 Million for Selected Medicare Part B Services Provided to Patients Residing in Nursing Homes, HHS Office of Inspector General.

270 days: that is the longest a state lets a Medicaid health plan sit on a tip about provider fraud before reporting it, according to a federal watchdog that found some states set no deadline at all. The Office of Inspector General posted report OEI-03-23-00340 on July 21, 2026, finding states’ contracts with Medicaid managed care organizations, the private insurers that administer coverage for most Medicaid enrollees, vary widely on how fast a plan must report suspected provider fraud, with required timeframes ranging from 1 day to 270 days; the report was issued July 16, 2026. Several states also impose no contractual consequence on a plan that misses its deadline, and many give plans no training or feedback on how to make fraud referrals properly. The Office of Inspector General recommended the Centers for Medicare and Medicaid Services require prompt, enforceable referral rules and expand feedback to plans; the agency agreed with two of the four recommendations and said it has begun related work on the rest. Confidence: High on the findings and the agency’s response, since the Office of Inspector General’s own report confirms them directly. Source: States Have Missed Some Opportunities To Improve Medicaid Managed Care Organizations’ Provider Fraud Referrals, HHS Office of Inspector General.

Two days: that is how long a health insurance marketplace rule has been in effect while a federal judge keeps eight of its consumer cost provisions frozen. Judge Brendan Hurson of the U.S. District Court for the District of Maryland stayed eight provisions of the Centers for Medicare and Medicaid Services’ 2027 Notice of Benefit and Payment Parameters rule on July 16, 2026, days before the rule’s July 20, 2026 effective date, in City of Columbus v. Kennedy, a suit brought by Baltimore, Chicago, Columbus, Ohio, Pima County, Arizona, and two advocacy groups. The blocked provisions include an expansion of catastrophic health plan eligibility to people ineligible for tax credits, higher out-of-pocket maximums for certain bronze and catastrophic plans, loosened provider network adequacy requirements, and the elimination of standardized plan offerings; the judge found the plaintiffs showed a strong likelihood of success on their claim that the rule violates the Administrative Procedure Act. As of today, the rule’s effective date has come and gone and the eight provisions remain frozen, meaning insurers cannot yet apply the blocked terms to marketplace enrollees. Confidence: High on the ruling’s substance and date, since the court’s own opinion and multiple outlets confirm it; Low on how long the stay holds, since the underlying case has not been decided on the merits. Sources: Columbus v. Kennedy Opinion, July 16, 2026, Health Care Litigation Tracker, Georgetown University O’Neill Institute, District court pauses 8 provisions from 2027 notice of benefit and payment parameters final rule, American Hospital Association.