Federal Enforcement Intelligence Curated

Top-of-mind federal actions and authoritative resources. Federal enforcement data isn't published as a public API — these cards deep-link to the primary sources.

Featured January 14, 2026

Kaiser Permanente Pays $556M in Largest Medicare Advantage Fraud Settlement

Kaiser affiliates settled False Claims Act allegations for submitting invalid diagnosis codes to inflate Medicare Advantage payments. The settlement—the largest MA risk adjustment case ever—stemmed from systematic pressure on physicians to add diagnoses via medical record addenda without proper clinical basis.

Read DOJ Announcement →

OIG Enforcement Actions Criminal, civil & admin actions

OIG Work Plan Upcoming audits & priorities

LEIE Database Excluded providers — updated monthly

OIG Fraud Alerts Special advisories & bulletins

State Enforcement Feeds

Live state-regulator actions by region. Click a highlighted state below to jump to its feed.

Coverage Map

3 live · 4 coming soon · 44 under evaluation

Live Coming Soon Under Evaluation

California — DMHC Live

Source: CA Open Data

Blue Cross of California

Jul 22, 2025 $500,000 Fine

Failure to correct deficiencies including mishandling member complaints
Anthem Blue Cross

May 12, 2025 $750,000 Fine

Sending thousands of denial letters with incorrect information
Blue Shield of California

May 22, 2025 $300,000 Fine

Mishandling claims payments
Blue Shield of California

Jan 2025 $90,000 Fine

Grievance system failure (HSC 1368(a)(1)) - behavioral health claims denied despite authorization
UnitedHealthcare of California

Jan 2025 $70,000 Fine

Medical records delays; minor denied residential mental health treatment with inadequate explanation
Blue Shield of California

Jan 2025 $50,000 Fine

Urgent care access violation - patient unable to access specialist referral within 48 hours post-emergency
UnitedHealthcare Benefits Plan

Jan 2025 $20,000 Fine

Incomplete grievance resolution; claims agreed to reprocessing never adjusted
Blue Shield of California

Jan 2025 $16,000 Fine

Grievance processing delays; DME claim improperly denied; grievance not resolved within 30 days
Anthem Blue Cross

Dec 16, 2024 $3,500,000 Fine

Mishandling member complaints
Blue Cross of California

Aug 15, 2024 $850,000 Fine

Illegally limiting coverage of gender dysphoria services
Blue Shield of California

Aug 29, 2024 $250,000 Fine

Illegally billing members for contraceptive health care services
Multiple Insurers (Cigna, Health Net, Blue Shield, UnitedHealthcare, Meritage)

Jan 2025 Cease & Desist

Failure to timely reimburse, contest, or deny claims (HSC 1371(a)(1))