Plus: Woman sentenced to 6 years in prison for impersonating a nurse
 
February 3, 2026
 
 
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Incorrect billing code leads to millions in Medicaid overpayments in Colo.
Colorado's Medicaid program has been overpaying transportation providers in the Denver area millions of dollars each year since the Department of Health Care Policy and Financing instructed them to bill van service accommodating extra-large wheelchairs using the code for specialty ambulance transport. The higher code was little used until 2023, when other non-emergency medical transportation rates increased, along with fraud claims. The instructions were corrected in November, and the state is expected to save more than $60 million in fiscal 2026-27 alone. The state is also investigating whether upcoding or other abusive practices occurred.
Full Story: KUSA-TV (Denver) (1/31)
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Law Enforcement & The Courts
 
Former physician convicted of health care fraud, money laundering
Pankaj Merchia, a former physician in Massachusetts and Florida, has been convicted of health care fraud, money laundering and tax evasion. Prosecutors said Merchia ran two health care fraud schemes related to CPAP and BiPAP machines. Merchia allegedly billed for rentals for patients he hadn't seen in years, and when claims for equipment provided to his brother were rejected, Merchia set up a new business and submitted the claims, according to prosecutors.
Full Story: Daily Voice (1/29)
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2 arrested in Fla. for fraudulent Medicaid transportation claims
Two people have been accused of defrauding Florida's Medicaid program of more than $70,000, according to state Attorney General James Uthmeier. Alexander McKinnie allegedly submitted false claims worth more than $65,000 for non-emergency medical transportation that was never provided. Kara Morrison allegedly assisted McKinnie by submitting $7,000 worth of false claims.
Full Story: WFLA-TV (Tampa, Fla.) (1/29)
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Woman sentenced to 6 years in prison for impersonating a nurse
Leticia Gallarzo was sentenced to serve more than six years in federal prison for identity theft and practicing medicine without a license. Gallarzo pleaded guilty to allegations that she created a fake nurse's license and credentials and worked as a nurse in Michigan and Los Angeles and as a physician's assistant under another fake identity in Chicago. Gallarzo's attorney says she has a history of mental illness.
Full Story: The Associated Press (1/28)
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States start implementing SNAP work requirements
The Associated Press (2/1)
 
 
"Most favored nation" drug price plan under scrutiny
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Full Story: MeriTalk (1/30)
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No Surprises Act's dispute resolution process faces scrutiny
The No Surprises Act was enacted in 2022 to shield patients from unexpected medical bills that previously resulted from out-of-network care during emergencies or at in-network hospitals. The law removes patients from disputes between insurers and providers, mandating a negotiation period followed by a structured arbitration process if no agreement is reached. While the act has helped protect patients from direct billing shocks, industry experts argue that the resulting disputes between insurers and providers have escalated, raising questions about unintended financial consequences for the broader health care system.
Full Story: MedCity News (2/1)
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The Associated Press (1/30)
 
 
 
 
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1954-2026

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