The Regulator

2.5: that is the percentage cut to Medicare’s baseline physician payment rate for 2027 that just survived its public comment window, one day before the House committee that could reverse it held a hearing on how. The Centers for Medicare and Medicaid Services (CMS) closed the public comment period on its Calendar Year 2027 Medicare Physician Fee Schedule proposed rule September 14, 2026, a rule that sets next year’s nonqualifying Alternative Payment Model conversion factor at $32.84, down 1.68 percent, because a one-year 2.50 percent payment boost Congress gave physicians for 2026 under the Working Families Tax Cut law does not carry into 2027. One day later, September 15, the House Energy and Commerce Committee’s Subcommittee on Health held a hearing, “Examining Legislative Proposals to Reform Medicare Provider Payment and Bolster Health Care Cybersecurity,” examining 16 bills including the Patients First Act of 2026 (H.R. 9693), the Provider Reimbursement Stability Act of 2026 (H.R. 8163), and the Medicare Physician Data-driven Performance Payment System Act of 2026 (H.R. 8622), alongside cybersecurity measures like the Rural Hospital Cybersecurity Enhancement Act (H.R. 9908). Subcommittee Chairman Morgan Griffith and full committee Chairman Brett Guthrie said the hearing would “build on previous Subcommittee work to identify meaningful, long-term solutions to address persistent challenges related to Medicare physician payments.” CMS is expected to finalize the rule this fall ahead of its January 1, 2027 effective date; none of the bills examined Monday has cleared committee. Confidence: High. This run reviewed CMS’s own fact sheet and the House Energy and Commerce Committee’s own hearing announcement directly. Sources: Calendar Year (CY) 2027 Medicare Physician Fee Schedule Proposed Rule, Centers for Medicare and Medicaid Services, Chairmen Guthrie and Griffith Announce Legislative Hearing to Address Medicare Provider Payment Challenges and Bolster Cybersecurity in American Health Care, House Committee on Energy and Commerce.

A federal watchdog says Medicare Advantage insurers barely screen the medical equipment suppliers most likely to defraud them, the same corner of Medicare that just produced an 11-company, $3.4 billion fraud bust this newsletter covered last week. The Department of Health and Human Services Office of Inspector General (OIG) posted a report September 14, 2026, “Medicare Advantage Organizations and CMS Can Do More To Prevent Durable Medical Equipment Fraud in Medicare Advantage,” finding that Medicare Advantage organizations (MAOs) conduct far less screening of out-of-network durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers than in-network ones, that not all such suppliers are required to enroll in Medicare at all, and that CMS’s Preclusion List, the tool meant to block fraudulent suppliers from billing, has structural gaps bad actors can exploit. OIG cited a separate case in which suppliers are accused of fraudulently billing Medicare more than $10 billion for DMEPOS as evidence of the stakes, and recommended CMS require MAOs to strengthen out-of-network vetting, tighten the Preclusion List, and mandate Medicare enrollment for all DMEPOS suppliers billing Medicare Advantage, seeking new statutory authority if needed. CMS concurred with the recommendations or said it would consider them. Confidence: High. This run reviewed OIG’s own report page directly. Sources: Medicare Advantage Organizations and CMS Can Do More To Prevent Durable Medical Equipment Fraud in Medicare Advantage, HHS Office of Inspector General.

President Trump just gave the Pentagon 30 days to make sure every departing service member’s full medical record automatically follows them to the Department of Veterans Affairs, a fix aimed at the records gaps that have long slowed veterans’ benefit claims. Trump signed Executive Order 14426, “Accelerating Access to Veterans’ Benefits and Employment Opportunities,” September 8, 2026, published in the Federal Register September 14; it directs the Department of War (formerly Defense) to update its information technology systems so that all current servicemembers’ military personnel files, health records, and service treatment records transfer to the VA as soon as someone separates or is discharged. The two departments have 120 days to review their existing IT systems and software contracts, in coordination with HHS and the White House budget office, to ensure those systems can actually share personnel and medical files electronically, and the order also directs agencies to build new digital tools using artificial intelligence to speed up benefits-claim processing and to overhaul the Transition Assistance Program service members go through before leaving the military. Confidence: Medium-High. This run reviewed the White House’s own fact sheet directly; the Federal Register’s document page returned an automated verification wall to direct fetch this run, so the order’s Federal Register text was corroborated via Nextgov and Government Executive’s reporting rather than read independently. Sources: Fact Sheet: President Donald J. Trump Accelerates Veterans’ Access to Benefits and Employment Opportunities, The White House, Trump signs veterans benefits order calling for improved data sharing, Nextgov/FCW.

A Tennessee eye doctor who split single-use wound care products to bill Medicare and the state’s Medicaid program for treatments she never fully gave was sentenced to more than three years in federal prison this week. Chief U.S. District Judge William L. Campbell Jr. sentenced Helen Boerman, 48, of Brentwood, Tennessee, on September 10, 2026, to 42 months in federal prison plus one year of supervised release for a health care fraud scheme run through her practice, Brentwood Eye Care. Boerman admitted submitting roughly $11 million in false Medicare claims and collecting about $6.9 million over three and a half years, including billing for dates when patients had no appointment and for wound care products labeled single-use that she split and reused across multiple patients; prosecutors said she separately submitted false claims to TennCare, Tennessee’s Medicaid program, and the Federal Employees Health Benefits Program between March 2020 and October 2024. She was ordered to pay $6,970,583.50 in restitution. Confidence: Medium-High. The Department of Justice’s own press release for the U.S. Attorney’s Office for the Middle District of Tennessee returned no readable content to direct fetch this run, a recurring access issue with justice.gov noted in prior issues; this account relies on the release as reported directly by WSMV and NewsChannel 5. Sources: Brentwood Woman Sentenced to Federal Prison for $6.9 Million Health Care Fraud Scheme, U.S. Department of Justice, Middle District of Tennessee, Brentwood eye doctor sentenced to prison in $6.9M health care fraud case, WSMV.

Starting October 1, thousands of lawfully present Nebraska Medicaid enrollees who lack a green card could lose full coverage, under a federal eligibility change tied to this year’s tax and spending law. The Nebraska Department of Health and Human Services (DHHS) is notifying Medicaid members and applicants that Section 71109 of the federal reconciliation law known as the One Big Beautiful Bill Act narrows, effective October 1, 2026, which noncitizens qualify for full Medicaid coverage; people without lawful permanent resident status who hold certain statuses, including domestic-violence parolees under the Violence Against Women Act and other parolee categories, may lose eligibility, while green card holders and lawfully present noncitizens who are pregnant or under 19 remain covered. DHHS is urging affected enrollees to schedule medical, dental, and behavioral health appointments and refill prescriptions now, confirm their contact information is current, and note that those losing full coverage may still qualify for the Children’s Health Insurance Program, the Refugee Resettlement Program, or Emergency Medical Services Assistance. Confidence: Medium-High. This run relied on Nebraska DHHS’s outreach notice as reported by local television stations; the department’s own detailed eligibility-category webpage was referenced but not independently verified in full this run. Sources: Nebraska DHHS Medicaid Eligibility for Noncitizens, Nebraska Department of Health and Human Services, New federal requirements regarding Medicaid will change eligibility for certain noncitizens starting next month, KLKN.