The Regulator

The federal government sent $167 million to rural South Carolina providers this week, the latest and largest stop yet in a near-daily rollout of state payouts from a $50 billion program most readers have never heard of. Governor Henry McMaster and the Centers for Medicare and Medicaid Services (CMS) announced September 17, 2026 that CMS has delivered $167,299,900.69 across 228 grants to South Carolina hospitals, clinics and rural providers under the federal Rural Health Transformation Program, created by this year’s reconciliation law. The money funds new and modernized primary care, maternal and infant health, pediatric and behavioral health sites, plus mobile care units, telehealth, 24-hour pharmacy kiosks and cybersecurity upgrades, one-time awards meant to build lasting infrastructure rather than recurring operating support. South Carolina’s award is part of a cadence that has run almost daily this month, Connecticut received $50 million the same day and Mississippi received $104 million two days earlier, out of $50 billion CMS is distributing to all 50 states over five years. Confidence: High. This run reviewed CMS’s own press release directly. Sources: Trump Administration Announces $167 Million to Build Rural Care Sites, Upgrade Health Technology, and Strengthen Prevention Across South Carolina, Centers for Medicare and Medicaid Services.

A federal watchdog says two of the largest companies running Medicare Advantage plans overcharged the government a combined $177.8 million by submitting diagnosis codes their own patients’ medical records did not support, and both are refusing to pay it back. The Department of Health and Human Services (HHS) Office of Inspector General (OIG) posted audit reports September 15, 2026 finding that HumanaChoice (contract H5216) owes an estimated $130.9 million and UnitedHealthcare of Wisconsin (contract H5253) owes an estimated $46.9 million for 2020 and 2021, after reviewing samples of enrollee-years and finding medical records failed to support the high-risk diagnosis codes submitted for risk-adjustment payment in the large majority of cases reviewed for each plan. OIG recommended both companies refund the government; Humana said it “strongly disagreed with the OIG’s methodology and findings,” and UnitedHealthcare called the methodology “flawed,” with neither committing to repay. CMS, not OIG, will ultimately decide whether to pursue recoupment. Confidence: High. This run reviewed OIG’s own audit report pages directly. Sources: Medicare Advantage Compliance Audit of Specific Diagnosis Codes That HumanaChoice (Contract H5216) Submitted to CMS, HHS Office of Inspector General, Medicare Advantage Compliance Audit of Specific Diagnosis Codes That UnitedHealthcare of Wisconsin, Inc. (Contract H5253) Submitted to CMS, HHS Office of Inspector General.

The House committee that oversees Medicare voted along party lines this week to require the program’s own independent advisors to publish yearly comparisons of what Medicare Advantage costs versus traditional Medicare, a methodology fight with billions of dollars riding on the outcome. The House Committee on Ways and Means held a markup September 16, 2026 and voted 25 to 15 to send H.R. 4093, the Apples to Apples Comparison Act of 2025, to the House floor as amended, after adopting a substitute by voice vote and rejecting four Democratic amendments on roll call votes. The bill would require the HHS Secretary to publish detailed Medicare spending data broken out by county and metropolitan area, and require the Medicare Payment Advisory Commission (MedPAC), Congress’s own independent Medicare advisory panel, to conduct an annual retrospective analysis comparing average expenditures for Medicare Advantage enrollees against those in traditional Medicare starting this year. Bill sponsors say the goal is transparency for seniors choosing between the two; a health economist’s comment letter to the committee warned the bill’s methodology requirements could push MedPAC toward results “more favorable to health insurers,” undermining the commission’s independence. Confidence: Medium-High. This run reviewed the Ways and Means Committee’s own markup page directly; the bill’s MedPAC provisions were corroborated through committee and sponsor materials, since congress.gov’s bill-text page returned an access error to direct fetch this run. Sources: Markup of H.R. 4093 and Other Bills, House Committee on Ways and Means. Supplemental: Comments on the Apples to Apples Comparison Act of 2025, USC Schaeffer Center.

A Maryland pharmacy that supplies assisted living facilities agreed to pay $5.3 million this week after two of its own employees told the government it billed Medicare and Medicaid for drugs residents never had valid prescriptions for. The Department of Justice (DOJ) announced September 17, 2026 that Remedi SeniorCare Holding Corporation, based in Towson, Maryland, settled False Claims Act allegations that it dispensed and billed for prescription drugs lacking valid prescriptions to residents of assisted living facilities across multiple states between January 1, 2015 and March 31, 2021. The settlement resolves a qui tam lawsuit filed by two former Remedi employees, Maureen Gearhart and Laura Griffieth, who will share a portion of the $5.3 million recovery; DOJ’s Civil Division, the U.S. Attorney’s Office for the Southern District of Ohio and HHS-OIG worked the case together. Confidence: High. This run reviewed DOJ’s own press release directly. Sources: Maryland Long Term Care Pharmacy Pays $5.3M to Settle Allegations of Billing for Drugs Without Valid Prescriptions, U.S. Department of Justice.

Today is the deadline a group of congressional Democrats set for a product-safety regulator to explain why it wants hospitals nationwide to hand over identifiable emergency room records on every patient who walks in. Senators Edward Markey and Richard Blumenthal, joined by Representatives Jan Schakowsky and Kevin Mullin and several cosigners, sent the Consumer Product Safety Commission (CPSC) a letter, reported September 3, 2026, demanding it immediately suspend its NEISS-R program, which directs hospitals to send patient names, birthdates, addresses and diagnoses to CPSC contractor Konza Health, and giving the agency until September 18, 2026, today, to answer 11 questions about the program’s legal authority, privacy safeguards and eventual use of the data. CPSC’s Acting Chairman, Peter Feldman, has previously said the agency will publish the full list of diagnostic codes Konza screens for but has not given a timeline, and as of this run no public CPSC response to the lawmakers’ questions had been found; the agency still wants more than 100 hospitals sending records by the end of 2026. Confidence: Medium. This run relied on the lawmakers’ own press release and secondary reporting; CPSC.gov itself was not independently fetchable this run, a recurring access issue noted in prior editions. Sources: Senators Markey, Blumenthal, Representatives Schakowsky, Mullin Press Consumer Product Safety Commission to Halt Sweeping and Invasive Data Collection on Emergency Department Patients, Office of Senator Edward J. Markey, Democrats urge consumer product agency halt public health modernization project, Nextgov/FCW.