The Regulator

$1.6 billion: that is how much CMS says it has kept out of fraudsters’ hands in Medicare lab billing since the Trump administration took office, using artificial intelligence to catch phantom test claims before they get paid. The Centers for Medicare and Medicaid Services (CMS) announced August 28, 2026 that its program integrity analytics, mining Medicare fee for service claims with AI and machine learning models for unusual laboratory billing patterns, has produced $732 million in savings from revoking 157 fraudulent lab providers, more than $500 million in potentially fraudulent payments blocked through 185 suspensions among roughly 600 labs flagged for review, $276 million identified across 442 overpayments, and $127 million in payments halted from law enforcement referrals. CMS Administrator Dr. Mehmet Oz said “when laboratories bill Medicare for tests they never performed, it drains the Medicare Trust Fund and diverts resources away from beneficiaries who need them.” Confidence: Medium-High. CMS’s own newsroom page returned an access error to direct fetch this run; this account relies on the release’s figures as reported by trade press. Sources: CMS Prevents $1.6 Billion in Fraudulent Medicare Laboratory Payments, Centers for Medicare and Medicaid Services, Trump admin blocks over $1.6B in potentially fraudulent Medicare lab payments, Fierce Healthcare.

220,000: that is how many Connecticut residents could see health insurance premiums jump as much as 22.7 percent next year, an increase the state’s own Attorney General is now asking regulators to reject. Attorney General William Tong filed formal objections ahead of an August 26, 2026 public hearing before the Connecticut Insurance Department, targeting proposed 2027 rate increases from Anthem (12.8 percent for individual plans, 17.4 percent for small group), ConnectiCare (22.7 percent for individual plans), and UnitedHealthcare (18.9 percent for small group plans), covering roughly 220,000 people. Tong argued the increases outpace inflation, that insurers have not shown they are curbing upcoding and fraudulent billing or controlling surprise billing costs, and singled out ConnectiCare’s rocky transition after its acquisition by Molina Healthcare; state law requires the Insurance Department to find rates are not “excessive, inadequate, or unfairly discriminatory” before approving them, with a final decision expected in the coming weeks. Confidence: High. This run reviewed the Connecticut Attorney General’s own press release directly. Sources: Attorney General Tong Urges Rejection of Health Insurance Rate Hike Requests, Connecticut Office of the Attorney General.

25: that is how many consecutive court rulings the pharmaceutical industry has now lost trying to overturn Medicare’s power to negotiate drug prices, after the Fifth Circuit added its name to the list this week. The U.S. Court of Appeals for the Fifth Circuit ruled August 26, 2026 in National Infusion Center Association v. Kennedy, No. 25-50661, affirming a Western District of Texas summary judgment against the Pharmaceutical Research and Manufacturers of America (PhRMA), the National Infusion Center Association, and the Global Colon Cancer Association, rejecting their claims that the Inflation Reduction Act’s Medicare Drug Price Negotiation Program violates separation of powers, due process, and the Constitution’s excessive fines clause. A unanimous three judge panel, appointed by Presidents George W. Bush, Barack Obama, and Donald Trump, held that drug manufacturers have no protected property interest in selling to Medicare beneficiaries at a price of their choosing, because participation in Medicare and Medicaid, and therefore in the negotiation program, is voluntary. Confidence: High. This run reviewed the Fifth Circuit’s opinion, filed on the court’s public docket, directly. Sources: National Infusion Center Association v. Kennedy, U.S. Court of Appeals for the Fifth Circuit, 5th Circ. Upholds Drug Negotiations In Blow To Big Pharma, Law360.

76.9 percent: that is the share of patients who no longer needed the twice-monthly blood draws that define polycythemia vera, after the FDA approved the first drug built to mimic the body’s own iron-regulating hormone. The Food and Drug Administration (FDA) approved Mimrylo (rusfertide), made by Takeda after licensing the drug from Protagonist Therapeutics, on August 28, 2026 for adults with polycythemia vera, a rare blood cancer that forces the bone marrow to overproduce red blood cells, thickening blood and raising the risk of stroke, heart attack, and blood clots. In the pivotal VERIFY trial of 293 patients, 76.9 percent of those on Mimrylo avoided therapeutic phlebotomy, the repeated blood draws used to manage the disease, over 32 weeks, compared with 32.9 percent on placebo. Confidence: High. This run reviewed the FDA’s own drug approval announcement directly. Sources: FDA Approves First Drug of Its Kind for Polycythemia Vera, a Rare Blood Disorder, U.S. Food and Drug Administration.

“Several basic factual and substantive errors”: that is how the Consumer Product Safety Commission now describes its own slide deck that told hospitals nationwide their patients’ emergency room records were mandatory to hand over. After the American Hospital Association filed formal objections August 12, 2026 to a Consumer Product Safety Commission (CPSC) program pushing hospitals to route identifiable emergency department records, including names, addresses, and diagnoses, to a contractor called Konza Health under a $15.9 million federal contract, Acting CPSC Chairman Peter Feldman said August 24, 2026 that participation in the data collection effort, known as NEISS-R, remains voluntary, walking back outreach materials that had told hospitals in bold, underlined text that “hospitals are required to participate.” CPSC still wants more than 100 hospitals across all 50 states sending data by the end of 2026 to help it spot dangerous consumer products, but hospitals including Mass General Brigham and Harborview Medical Center and privacy advocates have pushed back on the scope of personal data being requested for a system meant to track product injuries, not general patient care. Confidence: Medium. This run relied on trade press coverage of the CPSC chairman’s statement and the AHA’s letter; CPSC has not published its own written policy reversal. Sources: Trump administration softens demand for hospitals to share emergency room medical records, Nextgov/FCW, Privacy Concerns Raised Over Government Demand for Hospital Emergency Room Data, HIPAA Journal.

$2.4 million: that is what a Tennessee Medicare Advantage provider will pay after a former staff physician blew the whistle on diagnosis codes the company allegedly invented to boost payments. The Department of Justice announced August 24, 2026 that Monogram Health Professional Services PC and Monogram Health Inc. agreed to pay $2.4 million to resolve False Claims Act allegations that from 2021 through 2023 they submitted diagnosis codes to Medicare Advantage plans that were not clinically accurate, not supported by patient records, and did not affect the patient’s actual care; the whistleblower, a former Monogram physician, will collect roughly $380,000 of the recovery under the False Claims Act’s qui tam provisions. Confidence: Medium. Justice.gov’s own press release returned an access error to direct fetch this run, a recurring pattern with DOJ; this account relies on the Justice Department’s Central District of California office release as reported by trade press. Sources: Medicare Advantage Provider Monogram Health Agrees to Pay $2.4 Million to Settle False Claims Act Lawsuit, U.S. Department of Justice, Central District of California, Monogram Health to pay $2.4M to settle Medicare Advantage upcoding allegations, Healthcare Dive.