FEATURED ARTICLES

White House Anti-Fraud Efforts Continue with Cancellation of Subsidies for 760,000 Allegedly Fraudulent ACA Enrollments

On September 22, 2026, the White House Task Force to Eliminate Fraud announced that it was canceling subsidy payments for 760,000 individuals enrolled in Affordable Care Act (ACA) insurance plans. Vice President JD Vance and CMS Administrator Dr. Mehmet Oz said the enrollments were unauthorized and fraudulent. They claimed that the cancellations would save an estimated $2.2 billion of taxpayer funds. In addition to the cancellations, CMS also announced a six-month moratorium on registering new brokers and agents who enroll individuals in ACA plans due to allegedly fraudulent and ineligible enrollments.

The announcement of payment subsidy cancellations occurred at a White House news conference. There, Vice President Vance stated the cancellations were necessary for various reasons, including individuals not being aware they were enrolled in ACA plans; individuals not being eligible for the program because they already had employer coverage; and enrollees’ annual income exceeding the eligibility threshold of 400% of the federal poverty level. Vance also claimed that some enrollees did not exist. He said administration officials were examining (and would potentially remove) another 419,000 enrollees suspected of fraud.

CMS also announced a crackdown on brokers and agents who assist individuals with enrolling in ACA plans. Some brokers and agents allegedly enrolled individuals without verifying their identity or eligibility for coverage. According to administration officials, brokers and agents (who can be paid as much as $25 a month by insurance companies for each new enrollee) generated 50,000 fake enrollments at a cost of $45 million to the government. As part of its anti-fraud effort, CMS stated it would require existing brokers and agents to reverify their identity and include their Social Security number or other identifying information to enroll new customers. Customers will also be required to electronically sign their applications for enrollment. CMS also announced a six-month, nationwide moratorium on issuing registrations for new agents and brokers who enroll individuals in ACA plans.

The enrollment removals and crackdown on brokers and agents are part of the current administration’s broader efforts to combat fraud, including pausing Medicaid funding for certain states and halting new Medicare enrollments for home health agencies and hospices.

Reporter, Doug Comin, Atlanta, GA, +1 404 572 3525, [email protected]

CMS Adds Medicare Options Related to Substance Use Disorder, Heart Failure, and Other Chronic Conditions

Effective Spring 2027, CMS will expand its “Advancing Chronic Care with Effective, Scalable Solutions” (ACCESS) Model to provide additional technology-supported care options for Medicare beneficiaries with certain chronic conditions.

CMS’s September 15, 2026, press release describes the ACCESS Model as utilizing an outcome-based payment model rather than paying solely for individual health services. According to CMS’s press release, the ACCESS Model has the potential to allow participating organizations to provide virtual care, health coaching, and remote monitoring, including through connected devices and wearables.

CMS also notes that the ACCESS Model could enable primary care professionals to refer Medicare beneficiaries to providers participating in ACCESS, who would work with the beneficiaries’ care teams.

Currently, the ACCESS Model offers care for Medicare beneficiaries with high blood pressure, diabetes, depression, and chronic musculoskeletal pain. According to CMS, three out of four people with Medicare qualify for at least one ACCESS track.

Under the Spring 2027 expansion, ACCESS tracks will apply to beneficiaries with heart failure, chronic obstructive pulmonary disease (COPD), and substance use disorders. ACCESS tracks will also apply to beneficiaries who seek tobacco cessation support, and will offer expanded support for beneficiaries with bone, joint, and mobility issues.

According to CMS, 160 organizations are already participating in ACCESS. CMS anticipates that additional organizations will be added to this list over the next ten years. CMS maintains a directory of participating organizations and covered conditions at Medicare.gov.

Participation in the program is voluntary and, according to CMS, does not negatively impact a beneficiary’s Medicare benefits, coverage, or provider choice. Medicare Advantage enrollees are not eligible for the program.

CMS’s press release on this expansion can be found here.

Reporter, William Mavity, Los Angeles, +1 213 218 4043, [email protected]

Global Wound Care Agrees to Pay Up to $525 Million to Resolve $1.5 Billion in False Claims Act Allegations

On September 14, 2026, bankrupt specialty wound care provider Global Wound Care Medical Group asked a Texas bankruptcy court to approve a settlement under which it will pay up to $525 million to the federal government to resolve its liability under the False Claims Act (FCA) for claims the government valued in excess of $1.5 billion. The California-based company, which operates under the name Wound Pros and is licensed in 20 states, called the settlement “the only viable pathway” to resolving the government’s claims and proceeding with its Chapter 11 reorganization. The settlement is the latest and largest in a series of FCA resolutions targeting wound care providers that have drawn coordinated enforcement attention from DOJ, HHS-OIG, and CMS over the past year.

The Settlement

Under the terms of the deal, Global Wound Care will pay a maximum of $525 million, half of which is restitution. Global Wound Care acknowledged in its motion that the government has “substantial evidence” supporting its claims of false Medicare billing, though it maintains it has defenses, and stated the settlement “provides a fair assessment of the litigation risk facing the debtor.” In addition to the monetary payment, Global Wound Care will be excluded from Medicare, Medicaid, and all other federal health programs for 50 years. The company has also agreed not to resubmit or appeal previously denied claims tied to the underlying allegations, to waive any right to bill patients or third-party payors for the covered claims, and to cooperate with the government’s ongoing investigation. In exchange, Global Wound Care will be released from the government’s claims under the FCA, the Program Fraud Civil Remedies Act, and common law theories of payment by mistake, unjust enrichment, and fraud. The company will also be permitted to retain up to $500,000 it would have otherwise owed the government to cover administrative costs associated with the bankruptcy and pay creditors.

Background

Global Wound Care is a specialty medical practice that works primarily with elderly patients, treating bed sores, ulcers, and similar wounds. The company filed for Chapter 11 bankruptcy protection in the Southern District of Texas in October 2024 after CMS contractor Qlarant suspended its Medicare payments on September 11, 2024, based on alleged fraud tied to certain claims. The suspension froze a large receivable book and cost the company more than 90 percent of its income. At the time of the bankruptcy filing, the government challenged the company’s assertion that the Medicare suspension came without notice, stating it had issued a document demand a year earlier for information related to possible false statements in billing claims and subsequently filed a civil investigation demand suit in California federal court after the company failed to respond.

In December 2024, Global Wound Care reached a stipulation with CMS under which the agency agreed to cover 75 percent of reimbursement claims and withhold the remaining 25 percent while the parties discussed settlement. That stipulation was extended several times. By spring 2025, Global Wound Care had negotiated a tentative settlement with the government, but the deal was not completed before CMS issued new rules and a fee schedule in October 2025 that significantly reduced the reimbursements paid for the company’s services. The resulting liquidity pressure ultimately caused Global Wound Care to cease operations in December 2025.

Enforcement and Regulatory Context

The Global Wound Care settlement is the largest in a series of recent FCA resolutions targeting wound care providers. In December 2025, DOJ announced the criminal sentencing of and related $309 million civil FCA settlement with the owners of Arizona wound graft marketing company Apex Medical, LLC. The Apex owners had pleaded guilty to conspiracy to commit healthcare fraud and wire fraud after causing over $1 billion in false claims for unnecessary amniotic wound allografts, including through kickback arrangements with a wholesale graft distributor. Both owners were sentenced to over 14 years’ imprisonment and ordered to pay over $1 billion in restitution. In November 2025, DOJ announced a $45 million settlement with the principal owner of Physicians Management LLC (Vohra), one of the nation’s largest bedside specialty wound care providers, to resolve FCA allegations of unnecessary surgical debridement procedures and related upcoding. Notably, the United States had filed its complaint against Vohra without a relator, reflecting the agency’s priorities to pursue skin substitute fraud on its own initiative.

CMS has also pursued significant regulatory changes in parallel with its enforcement actions. In September 2025, HHS-OIG released a report deeming skin substitutes “particularly vulnerable to questionable billing and fraud schemes,” noting that Medicare spending on skin substitutes had grown from just under $400 million in 2022 to over $10 billion in 2024. The following month, CMS issued its final rule for Medicare Part B’s 2026 Physician Fee Schedule, which changed the payment methodology for skin substitutes by reclassifying most products as “incident-to” supplies reimbursed at a standardized flat rate rather than as “biologicals” reimbursed at 106 percent of average sales price. CMS also announced it would implement a multi-year pre-payment review model for skin substitutes in six states. In November 2025, CMS Administrator Dr. Mehmet Oz stated that skin substitute billing was “massively inflating” Medicare spending and announced that a forthcoming Medicare fraud crackdown would focus on skin substitutes.

These FCA settlements and the accompanying regulatory activity signal that federal wound care enforcement is intensifying on multiple fronts, coordinating DOJ’s litigation authority with HHS-OIG’s oversight and CMS’ payment and pre-payment review reforms.

The bankruptcy filing is In re: Global Wound Care Medical Group, case number 24-34908, in the U.S. Bankruptcy Court for the Southern District of Texas.

Reporter,Robert Stenzel, Washington, D.C., +1 202-626-2643, [email protected]

CLIENT ALERTS

DOJ Revises False Claims Act Policies on Agency Guidance and Qui Tam Dismissals

On Friday, September 18, 2026, the Department of Justice (“DOJ” or “the Department”) announced two revisions to policies concerning the False Claims Act (“FCA”) that effectively reinstated prior guidance issued during the first Trump Administration potentially impacting companies and individuals involved in business transactions with the government. The first revised policy limits the force and effect of guidance documents from DOJ and other agencies, and the second directs DOJ attorneys to consider seeking dismissal of qui tam lawsuits deemed not in the interest of the United States, including during litigation. King & Spalding’s Client Alert on this topic is available here.

King & Spalding Health Law & Policy Forum West

Wednesday, October 14, 8:30 A.M. – 6:15 P.M. PT

In-Person

Join our distinguished faculty and industry leaders for the annual Health Law & Policy Forum West on Wednesday, October 14th in Marina del Rey. As the healthcare industry continues to evolve in response to economic pressures, patient needs and accelerating technological advances, this full-day program will cover the trending topics that lawyers, executives, managers and investors need to know as they adapt to changes associated with the new administration and more.

A keynote session will feature the Honorable Alex M. Azar II, the 24th U.S. Secretary of Health and Human Services and a recognized leader in healthcare innovation. During his tenure, he led transformative efforts to modernize the U.S. healthcare system, expanding telehealth, advancing interoperability of health records, increasing healthcare transparency and accelerating the shift to value-based care.

Attendees will also enjoy multiple networking opportunities, including a reception following the sessions.

The registration fee for the full program is $95.

For questions or to request an invitation, contact the K&S Events Team.