Dear Valued Clients and Colleagues,
Our first quarter of 2026 was dynamic with recent news coverage, civil and criminal case retentions, and expert insights.
Based on recent case experience, we are publishing timely content (anonymized to exclude any confidential material) to help you and your clients stay ahead in medical billing compliance, cybersecurity, Medicare strategy, and more. Below are all the latest posts from January 3, 2026, to present (most recent first).
News Coverage on Prosecuting and Defending Medical Billing Fraud Cases
I’m pleased to share that I was recently quoted in The Center Square (February 2026) on the challenges of prosecuting healthcare fraud in Florida.
“Arrigo, a medical billing expert who has testified as an expert at multiple trials, said Florida officials have their work cut out for them. ‘Prosecuting health care fraud is not for the faint of heart,’ he said in an interview. ‘It’s complex. … By necessity, making a case takes time, typically including an expert forensic review of a statistically valid sample of medical records and medical bills.’ ”
Read the full article here
Medical Billing and Coding
While inflation and higher repair costs certainly play a role in some premium pressures, my 15 years of experience as an expert witness in usual, customary, and reasonable (UCR) charges for medical bills in personal-injury and auto-liability cases shows that systemic issues in how bodily-injury (BI) claims are valued and litigated are a far more significant driver of rising auto insurance premiums than general inflation.
Read the full article here
Personal Injury cases filed after March 24, 2023, fall under Florida Tort Reform, which permits evidence of what insurance may pay in certain circumstances. However, Florida’s Tort Reform is silent regarding certain costs to the insured under the Affordable Care Act’s prescribed provisions for insurance, such as Out-of-Pocket Maximums (“OOPM”), Out-of-Network, Essential Health Benefits, Minimum Essential Coverage (“MEC”), Metal Plans with Varying Actuarial Levels, Plan Provider Networks, and Pre-Existing Conditions.
Read the full article here
Insurance Eligibility and Coverage, Impacts on Litigation Presumptions, Case Law
(March 11, 2026)
I have noted that case law in several states makes the presumption that, once an injured plaintiff reaches age 65, they automatically qualify for Medicare. This is actually NOT the case.
You have to qualify for Medicare by accumulating 40 work credits, pay a premium, and select the coverage by specific deadlines. Retirees may see Medicare Part B premiums automatically deducted from Social Security checks—sometimes multiple months at once. This post explains IRMAA surcharges for higher-income beneficiaries, appeal options, budgeting strategies (including Easy Pay and sinking funds), and how to contest surprise bills using accurate coding and documentation review.
Read the full post
In 2026, the AMA released 288 new CPT codes, with a major focus on laboratory and molecular testing.
This updated guide covers longstanding codes for common panels (Basic Metabolic, Comprehensive Metabolic, CBC, TSH, etc.), brand-new multiplex nucleic acid tests for STIs and joint pathogens, revisions to heavy metal testing, and new Proprietary Laboratory Analyses (PLA) codes such as 0524U for preeclampsia assessment. Includes billing tips to avoid denials and audits.
Read the full post
Two New In-Depth Articles on Medicare Incident-To Billing (March 9, 2026)
We published a pair of practical resources on this high-risk, high-reward billing method:
To increase access to care, Medicare and commercial insurers allow physicians to see a patient, develop a plan of care, and then allow midlevels to perform certain medical care under the physician’s supervision. Supervision rules in some specialties, like behavioral health have been relaxed to allow “General Supervision.”
Prosecutors have used blunt instruments to allege that providers have committed fraud without understanding that midlevels CAN perform certain services and the physician retains the right to bill for and receive reimbursement at the physician rate.
A clear, step-by-step decision tree covering the six core criteria for billing NPP services at 100% of the MPFS rate, 2026 virtual supervision updates, behavioral health exceptions, documentation requirements, and how medical billing expert witnesses help in audits and litigation
Read the full post here.
Analysis showing why compliant incident-to billing saves health plans money (100% MPFS under the physician’s NPI) while direct NPP billing or out-of-network UCR rates can cost payers significantly more. Includes real CPT examples (99214, 90837), a 2015–2021 reimbursement table, and compliance implications for practices.
Read the full post here.
(January 3, 2026)
Foundational overview of Medicare incident-to rules, the most common pitfalls that trigger audits and False Claims Act investigations, and the critical role qualified medical billing expert witnesses play in forensic reviews and courtroom testimony.
Read the full post
Healthcare Privacy, Cybersecurity
Healthcare providers, health plans, and clearing houses (formerly known as “Covered Entities”) and Business Associates are now called “Regulated Entities.”
The Notice of Privacy Practices (NPP) is a critical document required under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. It informs patients about how their protected health information (PHI) may be used, disclosed, and protected. In 2024, the U.S. Department of Health and Human Services (HHS) finalized a rule aligning HIPAA with the stricter confidentiality requirements for substance use disorder (SUD) patient records under 42 CFR Part 2 (“Part 2”). The compliance deadline for updating NPPs to reflect these changes was February 16, 2026.
Read in-depth comparisons between the pre-2026 NPP and this year’s updates here.
(March 16, 2026)
The March 2026 Iran-linked “Handala” wiper malware attack on Stryker Corporation destroyed data on over 200,000 systems. This post breaks down how the breach likely occurred and delivers actionable 2026 prevention strategies: multi-factor authentication, regular patching, employee training, penetration testing, and HIPAA/NIST-aligned disaster recovery planning.
Read the full post
We hope these resources deliver immediate value as you navigate 2026’s regulatory, reimbursement, and cybersecurity landscape. If your team needs expert consultation on medical billing compliance, audit defense, cybersecurity risk assessment, or expert witness services for litigation, please reply to this email or reach out directly—we are always happy to help.
