The Regulator

11: that is how many medical equipment suppliers the government just barred from billing Medicare Advantage after finding more than $3.4 billion in suspected fraud, including bills submitted for patients who were already dead. The Centers for Medicare and Medicaid Services (CMS) announced September 8, 2026 that it identified and barred 11 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers from billing Medicare Advantage (Part C) and Part D plans after finding more than $3.4 billion in suspected fraudulent billing across 2025 and 2026. Four of the suppliers had already been revoked from traditional Medicare and then shifted their billing to Medicare Advantage plans instead; others submitted no claims before 2025, billed for equipment beneficiaries never requested, or billed Medicare for people who had already died, including one Florida company that submitted $6.1 million for 500 beneficiaries and $12.3 million for 777 more beneficiaries on consecutive days in December 2025. A Texas company separately billed $5.5 million in orthotics claims. CMS Administrator Dr. Mehmet Oz said “fraudsters who take advantage of the recently deceased to line their pockets represent a level of indecency that we will not stand for.” Confidence: High. This run reviewed CMS’s own announcement directly. Sources: CMS Cracks Down on Massive $3.4 Billion Medical Equipment Supplier Fraud Scheme, Centers for Medicare and Medicaid Services.

A federal watchdog says California failed to return more than $99 million in Medicaid overpayments that its own fraud investigators had already identified. The Department of Health and Human Services Office of Inspector General (OIG) reported September 3, 2026 that California did not properly report and return Medicaid overpayments tied to 26 cases its Medicaid Fraud Control Unit closed in federal fiscal year 2023, including $113.3 million in paid-claim overpayments (a $47.8 million federal share), a $27,515 court-ordered award, and $74.9 million reported too late. In all, OIG found California should have reported $231.2 million in overpayments, $99.3 million of it owed to the federal government. OIG recommended California return the unreported federal share and fix coordination between the state Medicaid agency and its fraud unit; California agreed with three of the four recommendations but did not concur with one. Confidence: High. This run reviewed OIG’s own audit report directly. Sources: California Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases, HHS Office of Inspector General.

Three of South Carolina’s five Medicaid managed care plans still cannot show they treat mental health and addiction claims the same as medical claims, six years after federal parity rules took effect. A federal audit released September 3, 2026 by HHS’s Office of Inspector General found that three managed care organizations (MCOs) it reviewed could not provide accurate, complete data on how often they required prior authorization for mental health and substance use disorder (MH/SUD) services compared with medical and surgical care in 2023, and that South Carolina’s Medicaid agency did not adequately review MCO data on denied authorization requests. Two of the three MCOs remained noncompliant more than six years after the October 2017 deadline set by the Mental Health Parity and Addiction Equity Act’s Medicaid rules. OIG recommended South Carolina require its MCOs to keep accurate data, issue clearer parity guidance, and validate denials; the state agreed. Confidence: High. This run reviewed OIG’s own audit report directly. Sources: South Carolina Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization, HHS Office of Inspector General.

Illinois is due to become the first Midwestern state where terminally ill adults can legally take doctor-prescribed life-ending medication this week, but a federal judge could still block it three days before it starts. U.S. District Judge John Tharp heard arguments September 4, 2026 on whether to block the End-of-Life Options for Terminally Ill Patients Act (EOLA) from taking effect September 12, in a suit brought by disability rights groups arguing the law violates the Americans with Disabilities Act and the Affordable Care Act by making lethal medication available to adults with a prognosis of six months or less to live. Judge Tharp said he would rule before the law’s effective date. In a separate case, another federal judge in Chicago already granted a temporary restraining order, agreed to by all parties, exempting religiously affiliated health systems and physicians from having to discuss lethal medication with patients under the law. Confidence: Medium-High. This run relied on public-radio and wire reporting of the hearing and the separate court order; the underlying court filings were not independently retrieved. Sources: Judge weighing arguments to halt Illinois’ ‘medical aid in dying’ law ahead of Sept. 12 start, Capitol News Illinois.

A federal judge just ruled that a coalition of states can keep suing over the Trump administration’s decision to strip seven childhood vaccines of their recommended status, rejecting the government’s bid to throw the case out entirely. U.S. District Judge Vince Chhabria of the Northern District of California ruled September 8, 2026 that a coalition of states led by California, Arizona, and Pennsylvania has standing to challenge a January 5, 2026 Centers for Disease Control and Prevention (CDC) decision that removed rotavirus, meningococcal, hepatitis A, hepatitis B, influenza, COVID-19, and respiratory syncytial virus (RSV) vaccines from the childhood schedule’s universally recommended list, finding the states plausibly alleged the change would raise the cost of running their health programs and force them to rewrite state laws. Chhabria dismissed a separate claim over Health and Human Services Secretary Robert F. Kennedy Jr.’s replacement of vaccine advisory committee members; the case continues. Confidence: Medium-High. This run relied on court-press reporting that quoted the judge’s ruling directly and a legal-tracker’s docket entry; the order itself was not independently retrieved. Sources: Judge trims lawsuit challenging RFK’s new childhood vaccine schedule, Courthouse News Service, State of Arizona et al. v. Kennedy et al., Georgetown Health Care Litigation Tracker.

Medicare’s hospice benefit is getting a new name and a mandate for real-time data as CMS overhauls the system that tracks patient assessments. CMS published a modified system of records notice in the Federal Register September 9, 2026 renaming its “Hospice Item Set (HIS) System” to the “Hospice Outcomes and Patient Evaluation (HOPE) System” and adding real-time data collection at the time of patient assessments, a change CMS says is meant to improve understanding of patient care needs and care coordination. The revised routine uses take effect October 9, 2026, following a 30-day public comment period, and Medicare-certified hospices nationwide will need to adjust reporting workflows to the new real-time requirement. Confidence: High. This run reviewed the Federal Register notice directly. Sources: Privacy Act of 1974; System of Records, Federal Register.