The Regulator

Quest Diagnostics paid more than $13 million to settle claims that it gave referring doctors New York Giants hospitality and then billed Medicare and Medicaid for their lab tests. Per local reporting on the announcement by the U.S. Attorney’s Office for the District of New Jersey, Quest paid $13,014,576 plus interest to resolve Anti-Kickback Statute and False Claims Act allegations covering July 25, 2013 to August 3, 2022. The government alleged that suite seats at MetLife Stadium, food, alcohol and training camp events, bought through a 2013 Giants sponsorship deal, were offered to client decision-makers, with sales goals tied to the invitations. Who it hits: clinical laboratories that fund client entertainment. So what: three whistleblowers share $2,472,769, and Quest enters a five-year Corporate Integrity Agreement with the HHS inspector general that requires an independent review organization to test its audits of payments to referral sources. Confidence: Med. We could not load the text of the Justice Department release, so details come from the local report; Quest’s own quarterly filing separately disclosed federal subpoenas about its Giants relationship. Sources: U.S. Attorney’s Office, District of New Jersey release (headline only; page text did not load), Quest Diagnostics quarterly report for June 30, 2026, SEC filing. Supplemental: Hudson County View report.

CMS limited 2027 cuts to clinical laboratory fee schedule rates to 15% a year through 2029, according to the final physician fee schedule fact sheet. The Centers for Medicare & Medicaid Services (CMS) says the cap begins in calendar year 2027 and applies to payment reductions on the clinical laboratory fee schedule, the rate list Medicare uses to pay for lab tests. Who it hits: independent and hospital outreach laboratories that bill Medicare. So what: the cap slows how fast rates can fall in each of the next three years, and the fact sheet states no dollar estimate. Confidence: High on the provision, which comes from CMS; Low on any dollar effect. Sources: CMS fact sheet, CY 2027 Medicare Physician Fee Schedule final rule.

CMS delayed until January 1, 2029 its plan to pay for remote patient monitoring only when a practice’s own staff delivers it. The final 2027 physician fee schedule postpones, by two years, the limit that would stop Medicare paying when contractors furnish remote physiologic or therapeutic monitoring. Who it hits: remote monitoring vendors and the practices that outsource device management to them. So what: contractor-run programs are not cut off for 2027 or 2028, but CMS did finalize two other changes starting in 2027: therapeutic monitoring is limited to established patients, and a separate initiating visit is required when monitoring begins. CMS says it received comments on bundling the monitoring codes and may consider them later. Confidence: High; the provisions come from CMS. Sources: CMS fact sheet, CY 2027 Medicare Physician Fee Schedule final rule.

Same-day office visits with a minor procedure will be paid at 80% of the second service in 2027, not the 50% CMS proposed, and the complexity add-on gets a new modifier. In the same final rule, when a separate evaluation and management (E/M) visit happens on the same day as a zero-day global procedure, the higher-paid service gets 100% and the other 80%. The reduction was dropped for 10-day and 90-day global procedures. Who it hits: dermatology, gastroenterology and other procedural practices. So what: the add-on code G2211 becomes modifier B1 and raises the E/M payment by 16%, while new modifier B2 raises it 32% for Shared Savings Program accountable care organization practitioners and LEAD Model participants. Use is voluntary. Also in the rule: new advance care planning codes G0572 and G0573, and a first mandatory 340B Part D claims repository submission due September 30, 2027. Confidence: High; all figures come from the CMS fact sheet. Sources: CMS fact sheet, CY 2027 Medicare Physician Fee Schedule final rule.

UPDATE: Minnesota says the four-state Medicaid work-rule suit rests on a coercion claim, that threatening to withhold all federal Medicaid funding is unconstitutional. Minnesota Attorney General Keith Ellison, with the attorneys general of Oregon, New Mexico and Washington, argues that the penalty for declining to enforce the 2025 budget law’s work and eligibility requirements, loss of all Medicaid funding, exceeds Congress’s spending power under the 2012 Supreme Court ruling in NFIB v. Sebelius. Who it hits: the 1.2 million Minnesotans on Medicaid, about 1 in 5 residents; the state says hundreds of thousands could lose coverage. So what: the states want a ruling that participation in the work requirement is optional, and the rules are due to be implemented in 2027. Minnesota’s release does not name the court or set a hearing date. Confidence: Med; the figures are the state’s, and we have not read the complaint. Sources: Minnesota Attorney General press release.