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Abstract
Three health care fraud stories landed inside one week in late September 2026 and the internet merged them into one. This piece pulls them apart and checks each against the record.
DOJ’s National Fraud Enforcement Division: roughly 500 staff, five priorities, a June takedown of 455 defendants and $6.5B
Telemedicine sentences now landing for 2014 to 2020 conduct, incl. 10 yrs for an NP who wrote compliance books after her indictment
A $26M TRICARE TMS conviction where 32 percent of collections went back out as patient kickbacks
CMS’s Aug 31 cancellation of about 315K exchange policies covering 760K people, $2.2B in APTC, 569 broker notices and a freeze on new agents
The 35 percent zero-claims stat: enrollment duration alone gets to 28 percent
Confirmed improper enrollment is about 4 percent of the exchange. The claims run from 13 to 35
Who ate the money, which gaps remain, where the business is
Table of Contents
One week, three programs
What the Fraud Division is and what June showed
Telemedicine cases are running six to nine years behind
The TRICARE TMS case and the paid patient
What CMS did on August 31
The 35 percent problem
Who ate the money
The gaps still open and where the business is
