CMS Exclusion Authority Without a Conviction: 2026 Delegation
On October 14, 2026, HHS delegated Section 1128(b) permissive exclusion authority to the CMS Administrator. CMS can now exclude providers from every federal health care program on claims data alone, with no conviction and no referral to OIG. Former DOJ Fraud Section prosecutors explain the grounds, the 30-day notice of intent response, the ALJ appeal, reinstatement, and four defense points the early commentary has missed.
Medicare Lab Payment Suspensions: Responding to CMS's $1.6 Billion AI Fraud Crackdown
CMS used AI analytics to suspend 185 labs and revoke 157. How the 15-day rebuttal, the revocation appeal, and the fraud investigation that follows fit together, from former DOJ prosecutors.
Laboratory Fraud Defense 2026: DermTech Settlement & Executive Exposure
Laboratory Fraud Enforcement in 2026: DermTech Settlement, National Takedown Charges, and Criminal Exposure for Lab Owners and Executives.
18 U.S.C. § 1347 Healthcare Fraud: Elements, Defenses, and Federal Enforcement
18 U.S.C. § 1347 is the lead charge in nearly every federal healthcare fraud case. Former DOJ Fraud Section prosecutors Scott Armstrong and Drew Bradylyons break down the four elements the government must prove, why a Medicare rule violation is not a crime, why good faith is a complete defense, and how prosecutors pair the statute with 18 U.S.C. § 1035 and the Anti-Kickback Statute.
Operation Never Say Die: Federal Hospice Fraud Arrests and CMS Payment Suspensions
Eight defendants arrested and 221 hospice providers suspended in Operation Never Say Die. Analysis of the federal charges, CMS payment suspension procedures under 42 C.F.R. 405.371, and the strategic risks of responding to a suspension notice while a parallel DOJ criminal investigation may be active.