The Regulator

22.2: that is the average percentage more Washington state residents who buy their own health insurance will pay in 2027, after a federal tax credit that used to cut $1,330 off the average yearly premium expired. Washington’s Office of the Insurance Commissioner (OIC) approved an average 22.2 percent rate increase for the state’s 2027 individual health insurance market this week, trimming the 13 insurers’ original 22.4 percent request. The increase covers the roughly 250,000 Washingtonians who buy coverage on their own rather than through an employer; individual company requests ranged from Regence BlueShield’s 6.7 percent to Community Health Plan of Washington’s 30.5 percent, and Providence Health Plan is leaving the market entirely. Insurance Commissioner Patty Kuderer said regulators had little choice but to approve the increases: “If we were to say no, you can’t raise the rates that much, they would simply just leave the market here.” News coverage of the decision ties the jump in part to the expiration of enhanced federal Affordable Care Act (ACA) premium tax credits, which had cut about $1,330 a year off the average enrollee’s premium; losing that subsidy pushed healthier members out of the risk pool, leaving insurers with costlier enrollees to cover. Confidence: Medium-High. This run reviewed OIC’s own rate-filing announcement directly; the final 22.2 percent approved figure and Commissioner Kuderer’s quote were corroborated by contemporaneous news coverage of the agency’s decision, since a standalone OIC release announcing the final number could not be located this run. Sources: Thirteen Health Insurers Request Average 22.4% Rate Increase for 2027 Individual Market, Washington State Office of the Insurance Commissioner, WA Insurance Commission approves major rate hike for residents; average 22% increase for 2027, KIRO 7 News.

A Brooklyn adult daycare operator, whose network billed Medicaid for care that regulators say was often never delivered, was sentenced to 76 months in federal prison this week. U.S. District Judge Natasha C. Merle sentenced Zakia Khan on September 10, 2026, for leading a $68 million Medicaid fraud and kickback scheme run through two Brooklyn adult daycare centers, Happy Family Social Adult Day Care Center and Family Social Adult Day Care Center, plus a home health staffing company, Responsible Care Staffing. Prosecutors said Khan and her network paid kickbacks to Medicaid recipients from October 2017 through July 2024 to enroll them in daycare and home care services that were frequently never provided, then laundered proceeds through a shell company. Khan was ordered to pay $56 million in restitution and to forfeit $5 million in fraud proceeds, including two properties, cash and gold jewelry seized from her home; she is one of eight people indicted in the case in October 2024. Confidence: Medium-High. The Department of Justice’s own release for the U.S. Attorney’s Office for the Eastern District of New York could not be independently retrieved this run, a recurring access issue with justice.gov noted in prior issues; this account relies on the release as reported directly by Hoodline. Sources: Brooklyn Adult Daycare Owner Sentenced to 76 Months in Prison for Leadership Role in $68 Million Medicaid Fraud Scheme, U.S. Department of Justice, Eastern District of New York, Brooklyn Daycare Owner Sentenced in $68M Fraud, Hoodline.

Medicare paid Medicare Advantage insurers at least $12.7 billion in quality bonuses last year, and the government’s draft scorecard for 2027 just made half of the thresholds insurers need to hit to earn them harder to reach. The Centers for Medicare and Medicaid Services (CMS) circulated draft 2027 Star Ratings cutpoints, the thresholds that convert a Medicare Advantage plan’s quality and performance scores into its 1-to-5 star rating, to insurers this week ahead of official results due in early October. An analysis by Medicare Advantage consultancy Newton Smith Group found roughly half of the cutpoints got harder to hit, most of them tied to Healthcare Effectiveness Data and Information Set (HEDIS) clinical-quality measures, while a third held steady and less than a fifth eased. Because CMS ties billions of dollars in annual bonus payments to a plan’s star rating, even a half-star drop can cost an insurer hundreds of millions of dollars; Humana has said its enrollment in 4-star-or-better plans fell from 94 percent in 2024 to 25 percent in 2025, a swing analysts have tied to more than $1 billion in lost bonus revenue. Confidence: Low. CMS has not yet posted the 2027 draft cutpoints publicly; this account relies on Healthcare Dive’s review of the circulated figures and Newton Smith Group’s analysis rather than the agency’s own document. Sources: Half of Medicare Advantage stars thresholds harder to reach in 2027, Healthcare Dive.

The Leapfrog Group, the nonprofit that safety-grades more than 2,000 U.S. hospitals twice a year, is fighting to overturn a court ruling that called its grading system deceptive, after filing its opening appellate brief this week. Leapfrog filed its opening brief September 10, 2026 in its appeal to the U.S. Court of Appeals for the Eleventh Circuit, challenging a Florida federal judge’s March 2026 ruling that its methodology for grading hospitals that decline to participate in its survey was deceptive under Florida law. The district court had ordered Leapfrog to delete the disputed grades for five Florida hospitals, Good Samaritan Medical Center, Delray Medical Center, Palm Beach Gardens Medical Center, St. Mary’s Medical Center and West Boca Medical Center, and barred it from using the same or a similar methodology going forward; Leapfrog has since said it will stop grading any hospital that does not participate in its survey. The hospitals’ response brief is due November 13, 2026. Confidence: Medium-High. This run relied on the Georgetown Health Care Litigation Tracker’s docket summary; the appellate brief itself was not independently reviewed. Sources: Good Samaritan Medical Center Inc. et al. v. The Leapfrog Group, Georgetown Health Care Litigation Tracker.

Federal regulators just gave a green light to a referral-service business model connecting patients who cannot hear well with the hearing professionals who treat them, without triggering the anti-kickback law that governs most patient referrals in federal health programs. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) posted Advisory Opinion 26-18 on September 9, 2026, finding it would not impose sanctions under the federal Anti-Kickback Statute on a proposed referral service connecting patients who need specialized ear and hearing care with hearing professionals. OIG’s advisory opinions are legally binding only for the company that requested them, but they function as a signal to the broader industry about which referral and marketing arrangements the agency currently treats as low-risk. Confidence: High. This run reviewed OIG’s own opinion summary directly; the full opinion document was not independently reviewed for additional fee or structural detail. Sources: Advisory Opinion No. 26-18, HHS Office of Inspector General.