Policy & Compliance

  • June 11, 2026

    HHS OIG Reports 'Concerning' Medicare Advantage Denials

    A pair of reports released by the inspector general for the U.S. Department of Health and Human Services on Thursday found that UnitedHealth Group, Humana and CVS Health logged some of the highest prior authorization denial rates among their Medicare Advantage peers for post-acute care.

  • June 11, 2026

    Braidwood Files New Challenge To ACA Birth Control Mandate

    For-profit healthcare company Braidwood Management and several individuals sued the government in Texas federal court to challenge no-cost contraception coverage requirements under the Affordable Care Act, arguing that the court should enjoin enforcement of the policy because it burdened their faith in violation of federal religious freedom law.

  • June 10, 2026

    Morgan & Morgan Atty Again Blocked From Harvard Suit

    A Massachusetts judge rebuffed a Morgan & Morgan PA attorney's second attempt to appear in a lawsuit over the theft of body parts from a Harvard Medical School morgue, saying he would not reconsider his earlier decision to bar the attorney over an incident in a separate court involving fake AI-generated case citations.

  • June 10, 2026

    Judge Won't Certify Class Of Health Workers In No-Poach Suit

    An Illinois federal judge on Wednesday refused to certify a class of former healthcare employees claiming that their wages were suppressed by alleged no-poach agreements among DaVita, UnitedHealth Group's Surgical Care Affiliates and Tenet Healthcare Corp. unit United Surgical Partners International, ruling that the proposed class is too diverse.

  • June 10, 2026

    Abbott Offered Faulty Health Plan Option, Ex-Worker Says

    Abbott Laboratories violated federal benefits law by offering a health plan option with higher premiums and lower deductibles without disclosing that participants would always pay less if they chose a high-deductible plan, according to a proposed class action filed Wednesday in Illinois federal court.

  • June 10, 2026

    NJ High Court Says Nonprofit Hospital Gets Limited Immunity

    The New Jersey Supreme Court unanimously concluded Wednesday that a nonprofit federally qualified health center isn't immune from a patient's negligence suit under a statute shielding nonprofits organized "exclusively" for charitable or educational purposes, reversing a lower court's finding to the contrary.

  • June 10, 2026

    Insurance Cos. Score Dismissal Of Zepbound Coverage Case

    A D.C. federal judge Wednesday agreed to toss a proposed class action against CVS Caremark and CareFirst BlueCross BlueShield from a worker who challenged coverage denials for Zepbound to treat sleep apnea, holding an exclusion in his employee health plan that the companies administered complied with federal benefits law.

  • June 10, 2026

    Lab To Pay $4.9M To Settle AGs' COVID Test Pricing Suit

    Eighteen states' attorneys general have entered into a $4.87 million settlement with GS Labs to resolve claims that the defunct testing company overcharged consumers for COVID-19 tests, according to statements issued Wednesday.

  • June 10, 2026

    Houston Hospital System Settles Retirement Fee, Fund Fight

    A Texas hospital system agreed to settle a proposed class action from ex-workers alleging the healthcare nonprofit failed to curb excessive recordkeeping fees and remove underperforming funds from its $2.8 billion employee retirement plan, after a magistrate judge recommended denying its motion to dismiss an amended complaint in May.

  • June 09, 2026

    Novartis, AbbVie Lose Bid To Halt Wash. 340B Pharmacy Law

    A Washington federal judge declined Tuesday to block a state law passed to protect prescription drug access for low-income and uninsured patients, rejecting arguments from AbbVie and Novartis that the new measure illegally adds to pharmaceutical manufacturers' obligations under the federal 340B Drug Pricing Program.

  • June 09, 2026

    Trans Care In Court: 7th Circ. Appeal, Atty Discipline And More

    Law360 Healthcare Authority looks at an emergency request related to the American Academy of Pediatrics, a Rhode Island judge's referral of Justice Department attorneys to a disciplinary committee, and other top news of the past week.

  • June 09, 2026

    Calif. Judge Blocks DOJ's Bid For Trans Patients' Medical Info

    A California federal judge ordered Stanford Medicine hospital not to disclose medical information belonging to trans adolescents who received gender-related care in response to a Texas grand jury subpoena, and blocked the U.S. Department of Justice from taking further steps to obtain their patient records.

  • June 09, 2026

    Eli Lilly Wins Order Halting Alleged Trulicity Fraud

    A Florida federal judge signed off Tuesday on a preliminary injunction pausing a prescription cost share program purportedly for Church of God in Christ members that pharmaceutical giant Eli Lilly and Co. says is actually a fraud scheme to resell GLP-1 drug Trulicity on the secondary market.

  • June 09, 2026

    Loper Battle Looms For Medicaid Frailty Work Exemption

    New federal work requirements for people on Medicaid take a strict view of who's too sick to work. They're almost certain to face legal challenges contending that the Trump administration went too far.

  • June 09, 2026

    4th Circ. Lets Hartford Unit Off The Hook For Drug Test Fight

    A Hartford unit doesn't owe coverage to a drug testing company accused of reporting false positive drug tests due to substandard quality control, the Fourth Circuit ruled Tuesday, saying the suit is related to an earlier claim that was covered by another insurer.

  • June 09, 2026

    The Law360 400: A Look At The Top 100 Firms

    The race to build the legal industry's largest law firm accelerated in 2025, with major firms leaning on mergers, lateral hiring and strategic expansion to climb the ranks of the Law360 400.

  • June 09, 2026

    Georgia County, Trans Deputy OK End To Surgery Bias Fight

    A Georgia county and a transgender sheriff's deputy who sued over her employee health plan's coverage exclusions for gender-affirming surgery have struck a deal to resolve her case, nine months after the en banc Eleventh Circuit issued a ruling that sided with the county. 

  • June 08, 2026

    Kaiser Member Seeks Class Cert. In Microsoft Site Tracker Suit

    A Kaiser Permanente member has called on a federal judge in Seattle to greenlight a series of national classes and California subclasses in her privacy lawsuit accusing Microsoft and Qualtrics of secretly intercepting millions of patients' private health information through tracking technologies embedded in the healthcare system's website.

  • June 08, 2026

    NC Doctor Avoids Prison For Role In $11M Medicaid Fraud

    A North Carolina doctor received five years of probation with eight months of house arrest for making false statements in an $11 million Medicaid fraud scheme, after a federal judge said he was struggling to balance the need to deter others with unwarranted sentencing disparities.

  • June 08, 2026

    Cleveland Clinic Deal With DOJ Bars Trans Care For Minors

    The Cleveland Clinic Foundation will pay over $2.3 million under agreements with the U.S. Department of Justice and the Ohio attorney general to prohibit the provision of puberty blockers and other forms of medical care for minors going through gender transition.

  • June 08, 2026

    Class Attys Want $11.6M In Fees From $35M Teva Inhaler Deal

    Berman Tabacco, Sperling Kenny Nachwalter LLC, Hilliard Shadowen LLP and five other firms have asked a Massachusetts federal judge for $11.55 million in attorney fees from a $35 million antitrust settlement resolving claims that Teva abused patent protections to delay generic competition for its QVAR asthma inhalers.

  • June 08, 2026

    HCA Unit To Pay $200K In EEOC Promotion Denial Suit

    An HCA Healthcare subsidiary has agreed to pay $200,000 to end a U.S. Equal Employment Opportunity Commission suit claiming it refused to promote a researcher because he was an Asian man in his 50s, the federal agency told a Tennessee federal court.

  • June 08, 2026

    Trump's $100K H-1B Fee Is Unauthorized Tax, Judge Rules

    A Massachusetts federal judge ruled Monday that President Donald Trump's $100,000 H-1B visa payment constitutes a tax that Congress did not authorize the president to impose, declaring the fee unlawful and vacating it in its entirety.

  • June 05, 2026

    HHS Can Issue Medicare Fines Without Jury, 4th Circ. Says

    The Fourth Circuit ruled Friday that the U.S. Department of Health and Human Services can seek monetary penalties from Medicare participants for violating program requirements without a jury trial, rejecting a Maryland nursing home operator's argument that Medicare participants are guaranteed that right.

  • June 05, 2026

    Trans Patients Urge Blocking DOJ 'Campaign Of Harassment'

    Transgender adolescents urged a California federal judge Friday to block a Stanford Medicine hospital from sharing gender-related care medical records in response to a Texas grand jury criminal subpoena, arguing that other courts have rebuffed similar government subpoena attempts and the judge should end the DOJ's "campaign of harassment."

Expert Analysis

  • What's New In FDA's Latest Cell And Gene Therapy Guidance

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    New draft guidance from the U.S. Food and Drug Administration, along with other recent initiatives, come together to promote cell and gene therapy product development by streamlining development and review pathways, say attorneys at Holland & Knight.

  • Adapting To Enforcement Focus On Wound Care Fraud

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    As federal agencies target wound care industry fraud as a top enforcement priority, attorneys advising industry stakeholders should evaluate business relationships for Anti-Kickback Statute violations, emphasize appropriate product use and documentation, and use internal data analytics to monitor billing patterns, say David Tarras at Tarras Defense and Jay McCormack at Verrill Dana.

  • AG Watch: Illinois A Key Player In State-Level Enforcement

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    Illinois Attorney General Kwame Raoul has systematically strengthened his office to fill federal enforcement gaps, oppose Trump administration mandates and advance state policy objectives, particularly by aggressively pursuing labor-related issues, say attorneys at Troutman.

  • Organ Transplant System Reforms Mark Regulatory Overhaul

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    Recent oversight, enforcement and operational developments in the U.S. organ procurement and transplantation system, alongside challenges like the federal shutdown, highlight heightened regulatory scrutiny and the need for compliance to maintain public trust, say attorneys at Hall Render.

  • Federal Grantees May Soon Face More Limitations On Speech

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    If courts accept the administration’s new interpretation of preexisting case law, which attempts to graft onto grant recipients the existing limitations on government contractors' free speech, a more deferential standard may soon apply in determining whether an agency’s refusal or termination of a grant was in violation of the First Amendment, say attorneys at Venable.

  • HHS Wound Care Report Highlights Need For Payment Reform

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    The U.S. Department of Health and Human Services' recent report on potential abuse in Medicare Part B payments for skin substitutes highlights specific fraud schemes, but more importantly emphasizes that broader changes are needed for the wound care sector's fundamentally flawed payment system, say attorneys at Paul Hastings.

  • Assessing The Future Of The HIPAA Reproductive Health Rule

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    In light of a Texas federal court's recent decision to strike down a U.S. Department of Health and Human Services rule aimed to protect the privacy of patients seeking abortions and gender-affirming care, entities are at least temporarily relieved from compliance obligations, but tensions are likely to continue for the foreseeable future, says Liz Heddleston at Woods Rogers.

  • DOJ's Tracing Rule For Pandemic Loan Fraud Is Untenable

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    In conducting investigations related to COVID-19 relief fraud, the government's assertion that loan proceeds are nonfungible and had to have been segregated from other funds is unsupported by underlying legislation, precedent or the language establishing similar federal relief programs, say Sharon McCarthy, Jay Nanavati and Lasya Ravulapati at Kostelanetz.

  • New Health AI Guidance Features A Provider-Centric Approach

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    New guidance from the Joint Commission and Coalition for Health AI regarding the responsible use of artificial intelligence in healthcare deviates from preexisting guidance by recommending a comprehensive framework for using AI tools, focusing on healthcare provider organizations rather than on AI developers, say attorneys at Ropes & Gray.

  • Mass. Ruling May Pave New Avenue To Target Subpoenas

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    A Massachusetts federal court’s recent decision to quash a subpoena seeking information on gender-affirming care at Boston Children’s Hospital is a significant departure from courts' deferential approach to subpoena enforcement, and may open a new pathway for practitioners challenging investigative tools in the future, say attorneys at Gibson Dunn.

  • What To Expect After FDA Warnings To GLP-1 Compounders

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    The U.S. Food and Drug Administration's recent warning letters to companies advertising compounded versions of GLP-1 medications raise questions not just about the enforcement outlook for marketing such products, but also about the future of drug compounding as a whole, say attorneys at Spencer Fane.

  • How Financial Cos. Can Prep As NYDFS Cyber Changes Loom

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    Financial institutions supervised by the New York State Department of Financial Services can prepare for two critical cybersecurity requirements relating to multifactor authentication and asset inventories, effective Nov. 1, by conducting gap analyses and allocating resources to high-risk assets, among other steps, say attorneys at Pillsbury.

  • How Courts May Interpret Data-Driven Healthcare Fraud Suits

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    As the U.S. Department of Justice and other agencies increasingly turn to data mining as an enforcement tool, courts will have to determine how far data alone can take a fraud case, and sound theory, clinical expertise and institutional context will play an important role, say Jaime Jones at Sidley and Andrée-Anne Fournier and Atang Gilika at Analysis Group.