Policy & Compliance

  • March 19, 2026

    11th Circ. Partially Reopens Aetna Twin Birth Coverage Fight

    The Eleventh Circuit on Thursday undid Aetna's escape from a worker's coverage dispute over an extended hospital stay for her newborn twins, agreeing with the lower court that allegations failed to state a claim for violating federal benefits law but holding that an amended complaint should have been allowed.

  • March 19, 2026

    Calif. Families Sue Rady Health Over Move To End Trans Care

    Four families have asked a state judge to prevent California's largest pediatric health system from cutting off gender-affirming care for minors, alleging the move would violate state antidiscrimination laws and leave them scrambling to find new providers, some more than 100 miles away.

  • March 19, 2026

    CVS, Caremark Pocket Money Meant For Rebates, Suit Claims

    CVS charges drug manufacturers "exorbitant" fees in exchange for pushing their products, then pockets the money instead of funneling it toward customer rebates as it promises, a federal lawsuit alleges, accusing the company of collecting billions of dollars at customers' expense and violating the anti-racketeering statute.

  • March 18, 2026

    Key Details As 3rd Circ. Ponders FCA's Fate, $1.6B J&J Fine

    Third Circuit judges Wednesday explored divergent views of the False Claims Act's constitutionality and a record fraud verdict against Johnson & Johnson, expressing little eagerness to gut the FCA's whistleblower mechanism, and voicing uncertainty about evidence and jury instructions underpinning the drug promotion punishment.

  • March 18, 2026

    SelectQuote Looks To Escape Investors' Kickback Probe Suit

    SelectQuote has asked a New York federal judge to dismiss a proposed class action accusing it of harming investors by concealing a kickback scheme, which is currently the subject of a suit by the U.S. Department of Justice, arguing the existence of the government's suit is not enough to show the shareholders were damaged.

  • March 18, 2026

    UnitedHealth Customers Denied Class Cert. In PrEP Suit

    Two UnitedHealthcare customers can't turn their Affordable Care Act lawsuit against a company subsidiary into a class action, a Minnesota federal judge ruled Wednesday, denying the pair's bid to represent thousands of customers in litigation accusing the subsidiary of failing to approve full coverage for PrEP.

  • March 18, 2026

    Ed. Dept. Flouting Mental Health Funding Order, States Claim

    The U.S. Department of Education is flouting orders that it fund K-12 mental health grants given to public schools by only partially funding the grants and threatening to withhold remaining funds, a group of state attorneys general told a Washington federal court.

  • March 18, 2026

    Doctor Gets 6½ Years For Healthcare Fraud, Tax Evasion

    An Anchorage, Alaska, physician was sentenced to six and a half years in prison for committing over $16 million in healthcare fraud and tax evasion as part of a scheme that injected sick patients with the wrong medications or dosages, the federal government said Wednesday. 

  • March 18, 2026

    ADA Challenge to Oregon Psilocybin Law Can Proceed

    An Oregon federal judge Tuesday rejected the state's health regulator's bid for a favorable judgment in a suit brought under federal antidiscrimination law, seeking to broaden access for homebound patients to the state's regulated psilocybin program.

  • March 18, 2026

    Health Litigator Rejoins Holland & Knight From In-House Role

    A former Holland & Knight LLP attorney has returned to the firm in Jacksonville, Florida, after a 10-year stint in-house at Florida Blue, a subsidiary of GuideWell Mutual Holding Corp.

  • March 18, 2026

    FDA Can't 'Refuse To File' Tobacco Applications, Suit Says

    The maker and a seller of Zone nicotine pouches are suing the U.S. Food and Drug Administration in Texas federal court, alleging the agency stalled and eventually refused to file their marketing application, despite federal law requiring the FDA to either approve or deny such applications.

  • March 17, 2026

    The Legal Reasoning That Put RFK's Vax Panel On Ice

    The legal reasoning behind a Massachusetts court's decision to freeze major changes to national vaccine policy is simpler than you might expect.

  • March 17, 2026

    9th Circ. Backs Rare FCA Theory In Huge Drug Prices Program

    In a novel and potentially far-reaching decision, the Ninth Circuit on Tuesday revived a major hospital chain's False Claims Act suit accusing large pharmaceutical companies of massive overcharges in a prominent drug discount program where pricing disputes are common.

  • March 17, 2026

    Dr. Oz Claims Florida Also Has Healthcare Fraud Problem

    Dr. Mehmet Oz, the administrator for the Centers for Medicare & Medicaid Services, announced Tuesday that he is taking his efforts to combat healthcare-related fraud to Florida, where he says millions of dollars have been wasted on schemes involving durable medical equipment.

  • March 17, 2026

    Chaperones Alone Not Enough To Prevent Abuse, Sidley Says

    A BigLaw team interviewed more than 120 witnesses as part of an investigation into failures that allowed an OB-GYN to sexually assault patients for 25 years. The report contains broader lessons on how to better protect patients.

  • March 17, 2026

    Ex-Database Administrator Settles OT Claim

    A former database administrator who accused Express Scripts and two other companies of misclassifying him as an independent contractor reached a $30,000 deal with the entities to settle his federal law claim, the parties told a New York federal court.

  • March 17, 2026

    State Lawmakers Take On Practice Limits: 3 Bills To Know

    Law360 Healthcare Authority looks at some of the latest moves by state lawmakers to relax practice restrictions in Florida, New York and Minnesota.

  • March 17, 2026

    Bipartisan Bill To Waive $100K H-1B Fee Gets AMA Backing

    Medical organizations and a bipartisan group of lawmakers are backing federal legislation introduced Tuesday that would exempt physicians and other healthcare workers from the Trump administration's $100,000 fee on H-1B visas.

  • March 16, 2026

    1st Circ. Affirms Block Of Trump's 'Unprecedented' Aid Freeze

    The First Circuit on Monday mostly upheld a lower court's order blocking the Trump administration from enacting a "sweeping and unprecedented categorical 'freeze' of federal financial assistance," ruling that the states involved in the suit will likely successfully show that the federal government acted arbitrarily and capriciously.

  • March 16, 2026

    Judge Tosses Kaiser Whistleblowers' Claims After $556M Deal

    A California federal court on Monday officially dismissed False Claims Act lawsuits from the federal government and three people alleging that Kaiser Permanente affiliates engaged in Medicare fraud, on the heels of Kaiser's $556 million settlement reached in January.

  • March 16, 2026

    Mich. Jury Awards $10M To Med Resident Fired During Leave

    A Michigan state jury has awarded more than $10 million to a former medical student who said she was fired from a hospital's OB-GYN residency program after being forced to take a required licensing exam while on maternity leave.

  • March 16, 2026

    HHS' Childhood Vaccine Policy Changes Put On Ice

    A Massachusetts federal judge on Monday blocked the Trump administration's modified childhood vaccine schedule and put all decisions made by Health Secretary Robert F. Kennedy Jr.'s federal vaccine policy committee on hold, finding they veered sharply from normal procedure and likely violated the law.

  • March 16, 2026

    Mass. City Accused Of Bias In Mental Health 911 Response

    The city of Worcester, Massachusetts, was hit with a suit Monday claiming that its 911 response is inadequate and discriminatory towards people with mental disabilities because the armed police who usually show up are ill-equipped to deal with those calls and often make matters worse.

  • March 13, 2026

    'Swinging Dicks' Dissent Stirs Uproar Across 9th Circ. Bench

    A raunchy dissent in litigation over transgender spa patrons prompted dozens of Ninth Circuit judges to denounce the "vulgar barroom talk" of a colleague, who returned fire by ridiculing his peers for adopting the "fastidious sensibilities of a Victorian nun."

  • March 13, 2026

    4th Circ. Brings Back Allergan Medicaid Overcharging Suit

    A split Fourth Circuit panel on Friday revived a whistleblower suit accusing an Allergan Sales LLC predecessor of overcharging Medicaid by more than $680 million, saying the whistleblower plausibly alleged the company knowingly improperly aggregated discounts into "best prices" for drugs.

Expert Analysis

  • What US Medicine Onshoring Means For Indian Life Sciences

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    Despite the Trump administration's latest moves to onshore essential medicine manufacturing, India will likely remain an indispensable component of the U.S. drug supply chain, but Indian manufacturers should prepare for stricter compliance checks, says Jashaswi Ghosh at Holon Law Partners.

  • FCA Working Group Reboot Signals EHR Compliance Risk

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    The revival of the False Claims Act working group is an aggressive expansion of enforcement efforts by the Justice Department and the U.S. Department of Health and Human Services targeted toward technology-enabled fraud involving electronic health records and other data, say attorneys at ArentFox Schiff.

  • FDA's Hasty Policymaking Approach Faces APA Challenges

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    Though the U.S. Food and Drug Administration has abandoned its usual notice-and-comment process for implementing new regulatory initiatives, two recent district court decisions make clear that these programs are still susceptible to Administrative Procedure Act challenges, says Rachel Turow at Skadden.

  • The Metamorphosis Of The Major Questions Doctrine

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    The so-called major questions doctrine arose as a counterweight to Chevron deference over the past few decades, but invocations of the doctrine have persisted in the year since Chevron was overturned, suggesting it still has a role to play in reining in agency overreach, say attorneys at Crowell & Moring.

  • A Rapidly Evolving Landscape For Noncompetes In Healthcare

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    A wave of new state laws regulating noncompete agreements in the healthcare sector, varying in scope, approach and enforceability, are shaped by several factors unique to the industry and are likely to distort the market, say attorneys at Seyfarth.

  • Arguing The 8th Amendment For Reduction In FCA Penalties

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    While False Claims Act decisions lack consistency in how high the judgment-to-damages ratio in such cases can be before it becomes unconstitutional, defense counsel should cite the Eighth Amendment's excessive fines clause in pre-trial settlement negotiations, and seek penalty decreases in post-judgment motions and on appeal, says Scott Grubman at Chilivis Grubman.

  • $95M Caremark Verdict Should Put PBMs On Notice

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    A Pennsylvania federal judge’s recent ruling that pharmacy benefits manager CVS Caremark owes the government $95 million for overbilling Medicare Part D-sponsored drugs highlights the effectiveness of the False Claims Act, as scrutiny of PBMs’ outsized role in setting drug prices continues to increase, say attorneys at Duane Morris.

  • DOJ Actions Signal Rising Enforcement Risk For Health Cos.

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    The U.S. Department of Justice's announcement of a new False Claims Act working group, together with the largest healthcare fraud takedown in history, underscore the importance of sophisticated compliance programs that align with the DOJ's data-driven approach, say attorneys at Debevoise.

  • Spotlight On Medicare Marketing Practices Enforcement Trend

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    Recent U.S. Department of Justice actions, including its recent Medicare kickback allegations in Shea v. eHealth, demonstrate increasing enforcement scrutiny on Medicare Advantage marketing practices, say Ellen London at London & Naor, Li Yu at Bernstein Litowitz and Erica Hitchings at the Whistleblower Law Collaborative.

  • Federal Regs Order May Spell Harsher FDCA Enforcement

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    A recent executive order aimed at reducing criminal prosecutions of those who unknowingly violate complex federal regulations may actually lead to more aggressive felony indictments under the Federal Food, Drug and Cosmetic Act, but companies and executives can mitigate risks by following several key principals, say attorneys at McGuireWoods.

  • What High Court's Tenn. Trans Care Ruling Means Nationally

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    The U.S. Supreme Court's decision in U.S. v. Skrmetti, upholding a Tennessee ban on gender-affirming medical care for minors, is fairly limited in scope and closely tailored to the specific language of Tennessee's law, but it may have implications for challenges to similar laws in other states, say attorneys at Hall Render.

  • High Court ACA Ruling May Harm Preventative Care

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    The U.S. Supreme Court's decision in Kennedy v. Braidwood last week, ruling that the U.S. Department of Health and Human Services secretary has authority over an Affordable Care Act preventive care task force, risks harming the credibility of the task force and could open the door to politicians dictating clinical recommendations, says Michael Kolber at Manatt.

  • Rising Enforcement Stakes For Pharma Telehealth Platforms

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    Two pieces of legislation recently introduced in Congress could transform the structure and promotion of telehealth arrangements as legislators increasingly scrutinize direct-to-consumer advertising platforms, potentially paving the way for a new U.S. Food and Drug Administration policy with bipartisan support, say attorneys at Sheppard Mullin.