The Regulator

$90 million: that is the federal rural health windfall CMS says South Dakota just delivered to 82 hospitals and clinics, out of 144 that applied for triple the money. The Centers for Medicare and Medicaid Services (CMS) announced August 19, 2026 that South Dakota is distributing $90 million of its federal Rural Health Transformation Program (RHTP) allocation to 82 rural health care organizations statewide, funding electronic health record modernization, cybersecurity upgrades, and expanded interoperability. South Dakota had 144 organizations apply for a combined $336 million, meaning most applicants went unfunded even as the state works through separate tranches of its award, including a previously announced $31 million “Rural Strong” round for 28 projects. RHTP is the $50 billion program Congress created in the 2025 reconciliation law (the One Big Beautiful Bill Act) to flow to all 50 states over fiscal years 2026 through 2030, split between a flat baseline payment every state already received in December 2025 and a workload-based formula; this week’s announcement shows how one state is now sub-granting that money to individual rural providers, a pattern other states are expected to replicate through the fall. Confidence: High. This run reviewed CMS’s press release title and figures corroborated directly by South Dakota news coverage of the same announcement; direct retrieval of CMS’s own page returned an access error. Sources: Trump Administration Announces $90 million to Modernize and Improve IT and Interoperability for South Dakota, Centers for Medicare and Medicaid Services, SD awarded $90 million in rural healthcare technology grants, Dakota News Now.

Up to 5 years: that is the prison exposure a former senior NIH infectious-disease official now faces after admitting he conspired to hide federal records about COVID-19 research grants from public requesters. David Morens, 78, who served as a senior advisor in the National Institute of Allergy and Infectious Diseases (NIAID) Office of the Director from 2006 through 2022, pleaded guilty August 18, 2026 in the U.S. District Court for the District of Maryland to conspiracy to defraud the United States by evading Freedom of Information Act (FOIA) requests and violating the Federal Records Act. HHS’s Office of Inspector General confirms the plea centered on communications about coronavirus research grants; press reporting on the case says Morens conspired with Peter Daszak of EcoHealth Alliance to destroy or conceal records after the National Institutes of Health terminated EcoHealth’s bat-coronavirus research grant, the funding relationship at the center of years of congressional inquiry into COVID-19’s origins. Morens, indicted in April 2026, faces sentencing November 12, 2026. Confidence: Medium. This run reviewed HHS-OIG’s own enforcement listing directly, which confirms the plea, charge, and date; the Daszak connection and sentencing details are drawn from press coverage after direct Department of Justice and news-outlet retrieval attempts returned access errors. Sources: Former Senior NIAID Official Pleads Guilty to Charges Connected to Concealing Federal Records During COVID-19 Pandemic, HHS Office of Inspector General, Ex-Fauci adviser pleads guilty to plotting to conceal COVID-19 research records during pandemic, NBC News.

$5.2 million: that is how much a Chicago-area podiatry practice kept billing Medicaid and Medicare for, federal and state prosecutors say, years after its own doctor was banned from both programs. The United States and the State of Illinois filed a joint complaint Monday, August 17, 2026, in the U.S. District Court for the Northern District of Illinois against Foot & Ankle Health Care Center, European Foot & Ankle Surgical Care, their owner Dr. Vadim Goshko, and billing companies Atlantic Wave Holdings and Atlantic Wave II, alleging the defendants kept billing Medicaid and Medicare more than $5.2 million for podiatry services Goshko performed after Illinois Medicaid had already terminated him from the program, by listing other physicians as the treating provider instead. The case began as a whistleblower suit under the False Claims Act filed by PayrHealth, which acquired the defendants’ billing company in December 2020, discovered the alleged scheme, cut ties, and reported it to the government; the government’s complaint seeks treble damages and civil penalties under the federal and Illinois False Claims Acts. This run could not independently retrieve the Department of Justice’s own press release, which returned an access error, so the story runs on direct reporting of the filed complaint by Illinois outlets; confidence tier dropped accordingly. Sources: Illinois Quick Hits: Feds, state allege $5M in false Medicaid, Medicare claims, The Center Square, Feds Take Over Whistle Blower Suit Against Podiatrist After Terminated from Federal Payments, McHenry County Blog.

August 24: that is the deadline drugmakers face this week to opt into a rebate scheme hospitals say will strip their working capital, reviving a program a federal court already killed once this year. The Health Resources and Services Administration (HRSA) republished its 340B Rebate Model Pilot Program in the Federal Register August 3, 2026, giving drug manufacturers until August 24, 2026 to submit rebate plans, with HRSA approvals due by September 24 and the pilot launching January 1, 2027. Under the revived pilot, covered entities such as safety-net hospitals and clinics would have to buy the affected drugs, those selected under Medicare’s Drug Price Negotiation Program for 2026 and 2027, at full wholesale acquisition cost and wait roughly 45 days for a manufacturer rebate rather than getting the 340B discount upfront, and unlike the original 2025 version, the new pilot carries no blanket exemption for critical access hospitals, children’s hospitals, or other financially vulnerable 340B entities. HRSA’s first rebate pilot was blocked by a federal court in Maine after the American Hospital Association sued and was formally vacated by the First Circuit in February 2026; HRSA revived the effort after a D.C. Circuit ruling in a separate case, Novartis v. Kennedy, confirmed the agency has legal authority to run a rebate model with its own approval, and the pilot’s return now runs on a collision course with the bipartisan SUSTAIN 340B Act this newsletter covered August 17, which would sunset HRSA’s rebate pilot within a year of passage. Confidence: High. This run reviewed law-firm summaries quoting the Federal Register notice directly; direct retrieval of the Federal Register page itself returned an access error. Sources: Notice Regarding 340B Rebate Model Pilot Program, Federal Register, 340B Rebates 2.0: HRSA Revives Its Pilot Program and Sets Up a Collision Course With Congress, National Law Review.

$15 billion: that is how much insurers paid out last year through the arbitration system for surprise medical bills, with providers now winning about 85 percent of the disputes they bring. CMS’s own federal independent dispute resolution (IDR) data for the second half of 2025, the most recent period the agency has published, shows nearly 1.4 million new disputes initiated in that six-month window alone, a 16 percent jump from the first half of the year, with providers filing 76 percent of all disputes and winning roughly 85 percent of the cases arbitrators decided. In about 87 percent of decisions the arbitrator-set payment exceeded the qualifying payment amount, the insurer-calculated benchmark rate the No Surprises Act uses as arbitration’s starting point, the same benchmark this newsletter reported August 19 that a federal appeals court found insurers had gamed with fake “ghost rate” pricing. CMS also reported the program has nearly cleared its early backlog, resolving 62 percent of second-half 2025 disputes within 30 days, up from 37 percent in the first half. Confidence: High on the dispute-volume and win-rate figures, drawn from CMS’s own supplemental data tables; Medium on a cumulative $2.8 billion in above-benchmark costs since the program’s 2022 launch, a figure from the Niskanen Center’s independent analysis of that same CMS data rather than a CMS-published total. Sources: Independent Dispute Resolution Reports, Centers for Medicare and Medicaid Services, No Surprises disputes continue to swell, CMS finds, Healthcare Dive.

September 21: that is the deadline to comment on a new federal records system tracking every nurse who takes CMS money to work in a nursing home, the paperwork trail behind an $80 million staffing push. CMS published a new Privacy Act System of Records Notice in the Federal Register today, August 20, 2026, establishing System No. 09-70-0545 for its Nurses for Nursing Homes Program (NNHP), which will hold records on individuals who apply for, receive, or administer loan repayment and stipend awards meant to draw registered nurses and licensed practical nurses into nursing home jobs; the public comment period runs through September 21, 2026. The records system formalizes the back end of CMS’s Nursing Home Staffing Campaign, an $80 million initiative that in June 2026 awarded 15 grants, ranging from $1.76 million to $20 million, to nonprofit and education organizations acting as “Financial Incentive Administrators” that distribute the loan-repayment and stipend money directly to nurses who commit to nursing home work, part of a federal minimum-staffing push that has drawn industry pushback over workforce shortages. Confidence: High. This run reviewed the Federal Register filing’s text via this newsletter’s monitoring pipeline’s direct API capture of today’s filings; a separate browser-style retrieval attempt on the same page returned an access error. Sources: Privacy Act of 1974; System of Records, Nurses for Nursing Homes Program (NNHP), Federal Register, CMS Posts NOFO For Nursing Home Staffing Campaign, American Health Care Association.