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# CMS finalizes $60M FY2027 psychiatric hospital payment rule with new outlier cap
- URL: https://members.americanhealthintel.com/2026-07-31-regulator/
- Published: 2026-07-31T09:53:20.000Z
- Updated: 2026-07-31T09:53:20.000Z
- Description: Plus: Houston lab pays $36.4M kickback settlement exposed by whistleblower. The day's rules, money, and enforcement, sourced and tiered below.
- Author: American Health Intel

Plus: Houston lab pays $36.4M kickback settlement exposed by whistleblower. The day's rules, money, and enforcement, sourced and tiered below.

| American Health Intel Rules · Money · Medicine · Decoded daily The Regulator Friday, July 31, 2026 CMS finalizes $60M FY2027 psychiatric hospital payment rule with new outlier cap Plus: Houston lab pays $36.4M kickback settlement exposed by whistleblower. The day's rules, money, and enforcement, sourced and tiered below. ![](https://americanhealthintel.com/email/pulse-divider.png) Rule Confidence: High CMS just finalized $60 million more in Medicare payments to psychiatric hospitals for 2027, the facilities that treat patients in mental health crisis, plus a new cap on their priciest cases. The 2.3% rate hike, published today, comes with a catch: starting in 2028, no psychiatric hospital can collect outlier payments above 20% of its total Medicare revenue in a year. Why it matters This raises what Medicare pays psychiatric hospitals for patient care next year and adds a new limit on how much a hospital can collect for its most expensive psychiatric admissions starting in 2028\. Watch whether the outlier cap changes how hospitals handle high-cost patients. Sources: [Federal Register](https://www.federalregister.gov/documents/2026/07/31/2026-15588/medicare-program-fy-2027-inpatient-psychiatric-facilities-prospective-payment-system-rate-update?ref=members.americanhealthintel.com) · [Aha](https://www.aha.org/news/headline/2026-07-29-cms-finalizes-23-payment-increase-inpatient-psychiatric-facilities?ref=members.americanhealthintel.com) Enforcement Confidence: Low A Houston genetic-testing lab, its former CEO and a Florida businessman are paying 36.4 million dollars after a whistleblower exposed a scheme to fake doctors' orders for unneeded tests. From 2018 to 2020 they paid kickbacks for referrals and unbundled billing codes. The whistleblower who exposed it, a Massachusetts marketing exec, collects 7.2 million dollars of the settlement. Why it matters A genetic-testing lab and two executives are paying $36.4 million after a whistleblower exposed a scheme that paid for referrals and unbundled billing codes for tests patients didn't need. It shows how one tipster can unwind a multi-year fraud scheme and trigger criminal pleas. Sources: [Ashingtontimes](https://www.washingtontimes.com/news/2026/jul/30/houston-lab-ex-ceo-florida-businessman-pay-364-million-kickback-case/?ref=members.americanhealthintel.com) · [Regtechtimes](https://regtechtimes.com/texas-laboratory-former-ceo-and-florida-businessman-pay-a-total-of-36-4m-to-settle-allegations-of-kickbacks-and-unnecessary-genetic-testing-doj/?ref=members.americanhealthintel.com) Also today Orlando VA employee and clinic CEO plead guilty in $14M kickback scheme [Read](https://americanhealthintel.com/editions/2026-07-31-regulator/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition#fimo-rivera-cassagnol-va-kickback-guilty-plea) Elevance exits DC Medicaid, 250K enrollees auto-switched starting tomorrow [Read](https://americanhealthintel.com/editions/2026-07-31-regulator/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition#dc-medicaid-wellpoint-elevance-exit-amerihealth) 328Records$19.6BEnforcement16Deadlines98Rules [Read this issue + the trackers](https://americanhealthintel.com/editions/2026-07-31-regulator/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) Pick your field on the site and every story tells you what it means for you. Reply to this email and tell us what you want covered. We read everything. We show our work. We score our own calls. [Track record](https://americanhealthintel.com/ledger/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) · [Calendar](https://americanhealthintel.com/calendar/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) · [Enforcement](https://americanhealthintel.com/enforcement/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fcampaign=edition) · [X](https://x.com/amhealthintel?ref=members.americanhealthintel.com) · [LinkedIn](https://www.linkedin.com/company/american-health-intel?ref=members.americanhealthintel.com) News and analysis, not legal, medical, coding, or investment advice.You subscribed at americanhealthintel.com · [Unsubscribe](%%{unsubscribe%5Furl}%%) |
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