Florida physician pleads guilty in $3.1M Medicare fraud; CMS moves to phase out fax machines; a bipartisan bill would cap insulin costs at $35 – Morning Medical Update

Florida physician pleads guilty in $3.1M Medicare fraud scheme

Simon Grinshteyn signed off on pre-populated orders for patients he never examined, federal prosecutors say.

A Florida physician has pleaded guilty to making false statements in connection with a Medicare fraud scheme that generated more than $3.1 million in fraudulent claims for medically unnecessary genetic testing and durable medical equipment (DME). Simon Grinshteyn, M.D., 52, admitted to signing pre-populated medical records and doctors' orders through a telemedicine company between February and June 2020, despite having no provider-patient relationship with the Medicare beneficiaries and generally never contacting them directly. DME suppliers and laboratories then submitted claims to Medicare based on those orders. Grinshteyn pleaded guilty to one count of making false statements relating to health care matters and is scheduled to be sentenced June 24, 2026, in federal court in Boston, where he faces up to five years in prison, three years of supervised release and a fine of up to $250,000 or twice the gross pecuniary gain or loss, whichever is greater.

CMS finalizes rule to replace fax and paper with electronic claims attachments

The regulation, effective May 2026, is projected to save the health care industry roughly $781 million annually.

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule requiring health plans, clearinghouses and providers to adopt national standards for electronically transmitting clinical documentation — such as medical records, lab results and clinical notes — used to support health care claims, replacing the fax and mail-based processes still common across health care. The rule also establishes standards for electronic signatures to ensure secure transmission of that information. Covered entities have until May 26, 2028, to comply. CMS projects the change will save the health care industry approximately $781 million per year by reducing administrative burden and delays tied to manual documentation methods.

“The 1980s called, and they want their fax machines back,” said CMS Administrator Mehmet Oz, M.D., MBA. “The futuristic medical breakthroughs we’ve achieved … shouldn’t have to coexist with administrative systems that often lag decades behind. This new rule will modernize American health care by standardizing electronic claims attachments and enabling secure electronic signatures.” The rule applies to HIPAA-covered entities and takes effect May 26, 2026.

Endocrine Society backs bipartisan bill to cap insulin costs at $35

The INSULIN Act would extend Medicare's existing co-pay cap to private insurance and create a program for uninsured patients.

The Endocrine Society has endorsed the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, a bipartisan Senate bill that would cap out-of-pocket insulin costs at $35 per month for people with private insurance and establish a grant program to help uninsured patients access the medication.

The bill, introduced by Sens. Jeanne Shaheen (D-NH), Susan Collins (R-ME), Raphael Warnock (D-GA) and John Kennedy (R-LA), would extend the $35 cap already in place for Medicare beneficiaries to the commercial market, require pharmacy benefit managers (PBMs) to pass insulin rebates directly to patients and encourage competition from generic and biosimilar insulins. Nearly one in five American adults with diabetes reported rationing insulin in 2021.

"This important legislation would ensure that people living with diabetes on private insurance are able to access this life-saving medication at no more than $35 per month," said Whitney Goldner, M.D., chair of the Endocrine Society's Clinical Affairs Core Committee.