Section 1115 Medicaid waivers have rewritten what state Medicaid programs will pay for in behavioral health. Operators who read the SMD letters, map waiver type to service line, and build the compliance infrastructure get paid. The rest watch the window close.
Vermont AG Charity Clark’s September 29, 2026 settlement with Washington County Mental Health Services puts behavioral health operators on notice: case-management time billed but not delivered is a False Claims Act problem. Here is the operator-side checklist to run before your state’s MFCU calls.
HHS-OIG just blessed a healthcare referral service under the Anti-Kickback Statute safe harbor. Behavioral health operators, MSOs, and PE buyers should read it carefully, because the AKS analysis does not cover EKRA, and that is where SUD referral money gets people indicted.
A Frisco, Texas mental health clinic owner was convicted on nine felony counts in a $26M TRICARE fraud scheme. Behavioral health operators can learn exactly which controls, statutes, and audit protocols separate a defensible billing operation from a federal indictment.
Federal prosecutors filed a civil forfeiture complaint on September 22, 2026 seeking $18.8 million from a Detroit-based addiction treatment nonprofit tied to Medicaid fraud and forced labor allegations. Here is what behavioral health operators should tighten this quarter to avoid the same exposure.
Founders and PE buyers keep opening treatment centers into markets that cannot support them. Sariah Hopkins lays out the four-factor viability test AHS uses on every feasibility engagement, tying SAMHSA demand data to state CON posture, payer network adequacy, and HRSA shortage overlays.
On September 8, 2026, the DOL issued Field Assistance Bulletin 2026-03 signaling continued MHPAEA scrutiny on NQTLs even after the 2024 Final Rule freeze. Here is what behavioral health operators should be doing with payer contracts, denial data, and single-case agreements right now.
Operators opening a sober living home in 2026 face a very different environment than they did five years ago. Between the Arizona AHCCCS fraud fallout, EKRA prosecutions, and tightening state statutes, the checklist has changed. Here is what actually matters before you accept your first resident.
A New Mexico afterschool program used minors’ Social Security numbers, invented psychological diagnoses, and billed Medicaid $6.6 million. The mother-daughter operators drew 4½-year sentences. Here is what behavioral health operators must tighten in intake, credentialing, and diagnosis substantiation to avoid the same trap.
A D.C. Community support worker just pleaded guilty to billing D.C. Medicaid for therapy sessions that never happened. Leah Kendall breaks down the control gaps operators must close: pre-payment edits, documentation reconciliation, dual verification, and a working corrective action plan tied to 42 CFR § 438.608.
