The Regulator

60 million dollars: that is how much more Medicare will pay the nation’s inpatient psychiatric hospitals next year, under a final rule the Centers for Medicare and Medicaid Services published in the Federal Register today, which also caps how much certain facilities can collect on their most expensive patients. The Centers for Medicare and Medicaid Services finalized CMS-1847-F on July 29, 2026, raising Inpatient Psychiatric Facility Prospective Payment System rates by a net 2.3 percent for fiscal year 2027, a 3.2 percent market-basket update reduced by a 0.9 percentage point productivity adjustment, for an estimated $60 million aggregate increase; the rule published in the Federal Register on July 31, 2026. Starting fiscal year 2028, the rule caps facility-level outlier payments, the extra money Medicare pays hospitals for unusually expensive stays, at no more than 20 percent of a facility’s total payments in a year for psychiatric hospitals with at least 50 covered stays annually, a guardrail against the kind of outlier-payment gaming that has drawn scrutiny in other post-acute settings. CMS also finalized dropping two Inpatient Psychiatric Facility Quality Reporting Program measures, on alcohol and tobacco use screening and treatment, starting with calendar year 2026 reporting and fiscal year 2028 payment. Confidence: High. The Federal Register’s own published rule and the American Hospital Association’s direct reporting on CMS’s figures corroborate each other; this run’s attempt to fetch CMS’s own fact sheet was blocked. Sources: Medicare Program; FY 2027 Inpatient Psychiatric Facilities Prospective Payment System-Rate Update, Federal Register, CMS finalizes a 2.3% payment increase for inpatient psychiatric facilities, American Hospital Association.

36.4 million dollars: that is what a Houston genetic-testing laboratory, its former chief executive and a Florida businessman are paying to resolve kickback allegations that a Massachusetts marketing executive first exposed in a whistleblower lawsuit. The Department of Justice announced July 30, 2026 that Access DX Laboratory, former chief executive Michael Stewart and Florida businessman Harold Shatz agreed to pay a combined $36.4 million to settle False Claims Act allegations that they paid kickbacks to marketers for patient referrals, unbundled billing codes for genetic tests, paid telemedicine providers for fraudulent doctors’ orders, and billed Medicare and Medicaid for medically unnecessary genetic testing from January 2018 through January 2020. Whistleblower Douglas Green, president of a Massachusetts marketing company the lab had hired, filed the original qui tam lawsuit and will collect $7.2 million of the settlement; Stewart pleaded guilty June 24, 2026 and Shatz pleaded guilty October 15, 2025 to related conspiracy and kickback charges, and Access DX separately entered a five-year Corporate Integrity Agreement with the Department of Health and Human Services’ Office of Inspector General requiring compliance training and referral-source audits. “Healthcare referrals must reflect the best decision for patients, not the influence of kickbacks,” Assistant Attorney General Brett Shumate said in the department’s announcement. Confidence: dropped. The Department of Justice’s own press release returned an access block this run, so this account rests on Washington Times and Regtech Times reporting that quotes the department’s announcement and settlement documents directly. Sources: Houston lab, ex-CEO and Florida businessman to pay $36.4 million in kickback case, The Washington Times, Texas Laboratory, Former CEO, and Florida Businessman Pay a Total of $36.4M to Settle Allegations of Kickbacks and Unnecessary Genetic Testing, Regtech Times.

14 million dollars: that is what an Orlando VA employee and the chief executive of a holistic-care clinic for military veterans billed the Department of Veterans Affairs for patients the employee steered there in exchange for kickbacks, both men admitted this week. Laurent Cassagnol, 43, an advanced medical support assistant for the VA Community Care Program, and Heriberto Rivera, 43, chief executive of Family Integrative Medicine of Orlando, pleaded guilty the week of July 30, 2026 to conspiracy to pay and receive illegal health care kickbacks and bribes, admitting Rivera paid Cassagnol to steer VA patients to FIMO for acupuncture, chiropractic adjustments and other holistic services that generated more than $14 million in claims to the VA, of which the agency paid more than $11 million. The Justice Department’s National Fraud Enforcement Division announced the pleas alongside the FBI’s Tampa field office and the VA Office of Inspector General’s Southeast field office; both men are scheduled for sentencing November 5, 2026 and face up to five years in prison. Confidence: dropped. The Department of Justice’s own press release returned an access block this run, so this account rests on Military.com and the St. Kitts Nevis Observer’s reporting, which republish the department’s announcement directly. Sources: VA Employee, CEO Plead Guilty to $14 Million Health Care Kickback Scheme, Military.com, CEO And VA Employee Plead Guilty To Paying And Receiving Illegal Health Care Kickbacks And Bribes, The St Kitts Nevis Observer.

250,000 Medicaid enrollees: that is how many Washington, D.C. residents get automatically reassigned to a new health plan starting tomorrow, after their insurer decided its government contract no longer pencils out. The District of Columbia Department of Health Care Finance notified enrollees and providers in Transmittal 26-19, dated July 3, 2026, that effective August 1, 2026, everyone currently enrolled in Wellpoint DC, the health insurer Elevance Health’s Medicaid managed-care plan for the District, will be automatically assigned to AmeriHealth Caritas DC, with a transition period through October 31, 2026 to preserve continuity of care and until January 31, 2027 to instead choose MedStar Family Choice DC. Elevance executives told investors the exit reflects a projected 1.75 percent operating-margin loss on the District’s Medicaid business, citing a mismatch between low state payment rates and high member medical acuity, and said the insurer plans to exit additional Medicaid markets over the next 12 to 18 months without naming them; the D.C. managed-care contract itself is worth an estimated $8.8 billion over five years, split among Wellpoint, MedStar and AmeriHealth. Confidence: Medium. The District’s own transmittal confirms the reassignment and effective date directly, but the $8.8 billion contract value and Elevance’s margin figures come from Healthcare Dive’s reporting on the insurer’s earnings call, which this run could not independently verify against a primary financial filing. Sources: Transmittal 26-19, Managed Care Plan Transition, D.C. Department of Health Care Finance, Elevance shuts down D.C. Medicaid business, eyes additional exits after passable Q2, Healthcare Dive.