Plus: New spending bill extends telehealth waivers, rural hospital programs
 
February 4, 2026
 
 
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Russian accused of money laundering in $3.4B Medicare fraud scheme
Federal authorities allege in a criminal complaint that a durable medical equipment company in Florida and another in Texas charged Medicare for more than 1.6 million orthotic braces, catheters, wound dressings and other items that were not needed, resulting in $3.3 billion in charges, nearly $1.8 billion of which was paid before payments were suspended. Nika Machutadze, a Russian citizen living in Austin, Texas, was charged with conspiracy to commit money laundering in connection with the scheme.
Full Story: KXAN-TV (Austin, Texas) (2/2)
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Law Enforcement & The Courts
 
Former physician settles Medicaid fraud case for $1.7M
Former physician Don Wagoner of Kokomo, Ind., and the now-shuttered Wagoner Medical Center have agreed to pay nearly $1.7 million to settle allegations of Medicaid fraud. Prosecutors say Wagoner submitted more than 5,000 fraudulent claims from 2011 to 2013 for extensive urine tests. Wagoner surrendered his medical licenses after being convicted on felony charges related to opioid prescriptions.
Full Story: WISH-TV (Indianapolis) (1/29)
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Former college football star convicted in Medicare fraud case
Joel Rufus French, a former college football All-American, has been convicted for his role in a $200 million health care fraud scheme that targeted Medicare and the Department of Veterans Affairs' civilian health program. The scheme, which garnered nearly $200 million through fraudulent billing, involved altering recordings and paying telemedicine companies for fake medical orders. French owned multiple medical equipment companies involved in these fraudulent activities and worked with overseas call centers that pressured Medicare beneficiaries into providing insurance information, according to prosecutors.
Full Story: Forbes (tiered subscription model) (2/3)
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Former USVI health department employees plead not guilty in Medicaid fraud case
Eleven people, including six who worked for the Virgin Islands Department of Human Services, entered not guilty pleas in a $309,000 Medicaid fraud case. The defendants are accused of bypassing eligibility safeguards in government computer systems, resulting in improper disbursement of Medicaid funds.
Full Story: WTJX (Christiansted, Virgin Islands) (2/1)
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Policy & Regulatory News
 
 
New spending bill extends telehealth waivers, rural hospital programs
Chief Healthcare Executive (2/4)
 
 
HHS guidance says direct pharma sales to consumers at low risk of violating kickback statutes
Healthcare Innovation (2/1)
 
 
 
 
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Tools & Technology
 
NITAAC cancels CIO-SP4 contract amid protests, policy shift
The National Institutes of Health Information Technology Acquisition and Assessment Center has announced it is canceling its $50 billion CIO-SP4 IT services contract. The CIO-SP4 contract faced numerous challenges, including over 350 protests and delays due to changes in proposal requests. With the cancellation, NITAAC will extend the previous CIO-SP3 contract until next year.
Full Story: MeriTalk (2/2)
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Alaffia Health raises $55M for AI claim review agent
Alaffia Health raised $55 million in a Series B investment round to support commercialization of an agentic AI platform for health care claim reviews. The platform extracts and analyzes clinical data from medical records and clinical documentation to ensure claims are consistent with health plan policies and guidelines. The tool is designed to assist clinicians reviewing claims.
Full Story: MedCity News (2/3)
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Health Insurance Industry News
 
Blue Shield of California fine-tunes prior authorization
Blue Shield of California is working to improve its prior authorization process by digitizing medical policies and integrating AI. The health plan has developed a centralized medical policy repository and partnered with Salesforce to create an interoperability hub, and it is working to automate more processes while ensuring that AI is not used to deny, delay or modify care, in compliance with state law.
Full Story: Healthcare Innovation (2/2)
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Medical News
 
 
How hospital CEOs are pursuing growth in 2026
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Nearly 80% of patients with high BP don't have it under control
HealthDay News (2/2)
 
 
 
 
What Your Colleagues Are Reading
 
Most-clicked stories in our last issue
 
 
Incorrect billing code leads to millions in Medicaid overpayments in Colo.
KUSA-TV (Denver) (1/31)
 
 
Former physician convicted of health care fraud, money laundering
Daily Voice (1/29)
 
 
Woman sentenced to 6 years in prison for impersonating a nurse
The Associated Press (1/28)
 
 
 
 
NHCAA News
 
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NHCAA's Platinum and Premier Supporting Members are leading providers of products and services to the health care anti-fraud industry, are valued partners who support NHCAA's mission, and have demonstrated outstanding commitment to the fight against health care fraud. Learn more about these companies on the Fraud Solutions Directory.
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Gladys West,
mathematician
1930-2026

February is Black History Month

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