The Regulator

26 states and the District of Columbia: that is the coalition of governments a federal judge told this week to keep preparing for Medicaid work requirements they wanted paused, five months before the rule takes effect nationwide. U.S. District Judge Richard G. Stearns of the District of Massachusetts ruled July 29, 2026 to deny a preliminary injunction in Commonwealth of Massachusetts et al. v. Oz et al., a suit 26 states and the District of Columbia filed June 29, 2026 against the Department of Health and Human Services and the Centers for Medicare and Medicaid Services. The states argued a June 3, 2026 interim final rule illegally narrows the “medically frail” exemption Congress wrote into this year’s Medicaid work-requirements law, adding a “significant impairment” standard and excluding people in stable substance-use-disorder recovery of five years or more. Stearns found the harm was not clearly attributable to CMS, writing that “this timeline was set by Congress in H.R. 1, not by CMS in the challenged IFR,” and said he was unconvinced the states’ costs were unrecoverable given CMS has agreed to reimburse 90 percent of states’ implementation expenses. The denial is without prejudice, the underlying case proceeds to a hearing on the merits, and work requirements are still set to take effect January 1, 2027, with states required to notify beneficiaries by August 31, 2026. Confidence: Medium. STAT News and AJMC’s direct reporting on the order are corroborated by the Georgetown University Health Care Litigation Tracker’s docket entry, but this run’s attempts to retrieve the court’s written order directly were blocked. Sources: Federal judge refuses to stop Medicaid work requirements, for now, STAT News, Commonwealth of Massachusetts et al. v. Oz et al., Georgetown University Health Care Litigation Tracker.

882.74 million dollars: that is how much more Medicare will pay skilled nursing facilities next year, under a final rule CMS issued that also orders every nursing home, not just the ones billing Medicare Part A, to start reporting the same patient data. The Centers for Medicare and Medicaid Services finalized CMS-1843-F on July 29, 2026, raising skilled nursing facility payment rates 2.4 percent for fiscal year 2027, a 3.3 percent market-basket update reduced by a 0.9 percent productivity adjustment, for an estimated $882.74 million aggregate increase. The rule requires all skilled nursing facilities to submit Minimum Data Set assessments for every resident receiving covered skilled care regardless of payer, not just Medicare Part A residents, and shrinks the Quality Reporting Program’s data-submission window from four and a half months to about 45 days starting with the fiscal year 2029 reporting cycle, cutting up to three months off the lag before the data becomes public. CMS also opened a request for information on measuring “case-mix creep” under the Patient-Driven Payment Model and finalized Value-Based Purchasing performance standards through fiscal year 2030, with VBP payment reductions not reflected in the base rate estimated at $203.6 million for fiscal year 2027. Confidence: Medium. CMS’s own fact sheet states these figures directly, but this run’s attempt to fetch the fact sheet was blocked, so this account also leans on independent corroboration from the American Hospital Association. Sources: Fiscal Year 2027 Skilled Nursing Facility Prospective Payment System Final Rule, CMS-1843-F, Centers for Medicare and Medicaid Services, CMS finalizes 2.4% payment update for SNFs, American Hospital Association.

350 million dollars: that is the fraud a Justice Department sweep says it uncovered across seven Southeastern states this week, the same day Washington signed all seven of those states up to share Medicaid, food-stamp and small-business-loan data with federal investigators going forward. The Department of Justice’s National Fraud Enforcement Division announced July 30, 2026 that it has charged 17 cases carrying more than $350 million in intended losses across Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina and South Carolina, and signed new data-sharing agreements with all seven states covering SNAP registration and payment records, Small Business Administration loan data and Medicaid records. In South Carolina, prosecutors charged Misty Dawn Woody, an employee of the medical transportation company Vital Care, with forging a physician’s signature on more than 100 Medicare certification forms for patients no longer under that doctor’s care, generating more than $1.8 million in fraudulent Medicare billings. Mississippi Attorney General Lynn Fitch announced a parallel “Joint Task Force Vigilance” with the department, and South Carolina Governor Henry McMaster called the effort “a nationwide operation that’s going to be pushed by the Department of Justice that will give it the power and the sustainability to get this done.” Confidence: dropped. The Department of Justice’s own press release returned an access block this run, so this account rests on Washington Examiner, Fox Carolina and WIS-TV reporting that quotes department and state officials directly. Sources: DOJ announces data sharing agreement with states after fraud found in southeast, Washington Examiner, South Carolina part of DOJ’s $350M regional fraud sweep, Fox Carolina.

3.4 million dollars: that is the fraudulent Medicare billing a New Jersey eye-care company’s own self-disclosure uncovered, and the reason the Justice Department let the company walk away while indicting its founder alone. The Department of Justice’s Fraud Division announced July 29, 2026 that it declined to prosecute Campus Eye Management Holdings LLC and its subsidiary Campus Eye Management LLC under Part I of its Corporate Enforcement and Voluntary Self-Disclosure Policy, crediting the company’s voluntary self-disclosure, cooperation and remediation, and requiring it to pay $1 million back to victims. The department separately indicted the company’s founder and former chief executive, 71-year-old E. Bruce DiDonato of Princeton, New Jersey, on seven counts including conspiracy to commit health care fraud and to violate the Anti-Kickback Statute, alleging that from 2015 through March 2023 he billed Medicare for unnecessary diagnostic eye tests and paid ophthalmologists kickbacks disguised as consulting fees tied to a percentage of Medicare reimbursements, generating about $3.4 million in fraudulent claims of which Medicare paid roughly $1 million. Campus Eye is described as the first health care company to secure a declination under the department’s newer corporate enforcement policy, giving other health systems a template for what self-disclosure buys. Confidence: dropped. The Department of Justice’s own press release and declination letter returned access blocks this run, so this account rests on Gazette NGR and USA Herald reporting that quotes the department’s charging documents and announcement directly. Sources: Campus Eye CEO Bruce DiDonato charged with multimillion-dollar Medicare fraud, Gazette NGR, DOJ Optometry Charge Lands on Founder as Company Walks Away Clean, USA Herald.

22 to 0: that is the vote by which a Senate committee just advanced a bill extending HIPAA-style privacy rules to health apps and wearables for the first time, the same day it split along party lines to advance President Trump’s pick to run the CDC. The Senate Health, Education, Labor and Pensions Committee voted July 30, 2026 to advance the Health Information Privacy Reform Act, which would direct the Department of Health and Human Services and the Federal Trade Commission to write privacy, security and breach-notification standards for health data collected by apps, wearables and other services HIPAA does not currently cover. The same session, the committee voted 13 to 10 to advance Erica Schwartz’s nomination as CDC director, with every Republican joined by Virginia Democrat Tim Kaine, and voted 12 to 11 along party lines to advance Sean Kaufman’s nomination as HHS Assistant Secretary for Preparedness and Response. Both nominations now go to the full Senate, where leadership is not expected to schedule a confirmation vote before the August recess, meaning a final vote may not come until September. Confidence: High on the nomination tallies, corroborated directly by Healio and Axios reporting on the committee’s own vote; Medium on the privacy bill’s unanimous tally, since this run could not independently confirm the roll call. Sources: Senators vote to advance Schwartz CDC nomination, Healio, Senate panel approves CDC nominee, controversial HHS pick, Axios.

October 2, 2026: that is the deadline Senate Finance Committee Democrats just set for the public to weigh in on dozens of proposals to lower what Americans pay for private health insurance. Senate Finance Committee Ranking Member Ron Wyden and a group of Senate Democrats released an 86-page request for information July 30, 2026 titled “Health Coverage That Works For Everyone,” seeking feedback on policy proposals to lower premiums and deductibles, expand coverage options, simplify enrollment and reform practices insurers use to delay or deny care. The RFI follows similar Finance Committee solicitations this year on drug pricing and long-term care, and Democrats say the feedback will inform comprehensive health insurance legislation they plan to draft, though as the minority party they do not control when or whether such a bill gets a floor vote. Confidence: Medium. The Senate Finance Committee’s own RFI document, dated and hosted on the committee’s website, establishes the deadline and Wyden’s role, but this run could not extract the document’s full policy detail, so this account also leans on Axios’s reporting on its contents. Sources: Health Coverage That Works For Everyone, Senate Committee on Finance, Senate Democrats lay out health insurance redesign targets, Axios.