A licensed North Carolina addiction specialist was sentenced to four years for a $1.9M Medicaid fraud scheme tied to phantom drug tests and psychotherapy. Here is how behavioral health operators should read the DOJ, HHS-OIG, and NC MID signal and rebuild claim validation now.
Tricare East credentialing runs through Humana Military under the T-5 contract. Here is how behavioral health operators should sequence accreditation, application, and revenue planning to avoid a 120-day cash gap and the mistakes that stall approval.
The One Big Beautiful Bill Act rewrites Medicaid eligibility, work requirements, and cost-sharing rules starting in late 2026. Here is how SUD treatment operators should reprice contracts, retool eligibility workflows, and stress-test census against six-month redetermination cycles before mid-episode coverage loss shows up in AR.
When a treatment center draws grant oversight, auditors look for a predictable pattern. Leah Kendall breaks down the six FWA red flags that trigger OIG and state auditor scrutiny, plus the internal controls behavioral health operators need before the post-award monitoring letter arrives.
CareSource’s retroactive clawbacks against Ohio behavioral health providers are a payer-solvency signal, not a one-off billing correction. Operators should stress-test pro formas, tighten MCO contract language, and prepare appeal playbooks before the next renewal cycle turns pressure into insolvency.
CMS is narrowing the runway for Medicaid-funded behavioral health inside jails and prisons. Reentry 1115 waivers still exist, but Trump-era guidance and the CAA 2024 suspension mandate are reshaping addressable markets. Operators and PE buyers eyeing correctional BH contracts need to reprice the vertical now.
A Texas businessman, a Kentucky physician, and a Kentucky administrator are heading to federal prison after fraudulently billing Medicare and Kentucky Medicaid $4.8 million through a chain of opioid treatment clinics. Leah Kendall breaks down what every SUD operator should audit right now to avoid the same exposure.
HHS-OIG is hunting a Brooklyn rehab owner over $18.4M in fraudulent Medicare and Medicaid claims. For behavioral health operators, the case is a working manual on what a real compliance program, chart audit cadence, and FWA controls need to look like right now.
The Department of Justice sentenced Done Global’s founder and clinical president in July 2026 for a $90 million Adderall distribution and health care fraud scheme. Behavioral health operators, particularly PE-backed platforms scaling telehealth, should read this as a direct signal on prescriber oversight and utilization review.
A behavioral health compliance officer walks through what it actually takes to launch an Intensive Outpatient Program: state licensure, ASAM Level 2.1 alignment, accreditation sequencing, EKRA exposure, and the capital math most consultants skip.
