Policy & Compliance

  • June 04, 2026

    Policyholder Attys Praise Kaiser's Damages Bid In FCA Row 

    Kaiser Foundation Health Plan's call for coverage of any multiplied damages in a $581 million False Claims Act settlement with the U.S. Department of Justice grabbed the attention of policyholder attorneys, who see a smart strategy to simplify litigation and are curious about how an AIG unit may respond. 

  • June 04, 2026

    Feds Tout Medicaid Fraud Crackdown In Ohio, Slam Hawaii

    The Trump administration on Thursday praised Ohio's fight against Medicaid fraud and said Hawaii was doing too little, as federal officials pushed states to ramp up anti-fraud prosecutions or risk the loss of federal funding.

  • June 04, 2026

    Cities, Doctors' Group Seek Bar On ACA Marketplace Reforms

    Several cities and groups representing doctors and small businesses urged a Maryland federal court to strike down recently finalized Affordable Care Act marketplace reforms, arguing they will strain community resources by increasing the population of underinsured and uninsured Americans.

  • June 04, 2026

    NC Doctor Seeks Probation In $11M Medicare Fraud Case

    A North Carolina doctor convicted of making false statements as part of an $11 million Medicaid fraud scheme has asked a federal judge in the state to not send her to federal prison and instead give her probation after a jury found her guilty.

  • June 03, 2026

    AbbVie Loses Miss. Discount Drug Law Challenge For Good

    A Mississippi federal judge on Wednesday threw out a suit brought by AbbVie and other pharmaceutical manufacturers that participate in Medicaid challenging a law barring their interference with the distribution of discounted prescriptions to pharmacies serving low-income patients.

  • June 03, 2026

    Judge Questions Terms Of Student Loan Forgiveness Change

    A Massachusetts federal judge considering whether to block a new Trump administration rule that could kick millions of public sector and nonprofit employees out of a student loan forgiveness program repeatedly pressed a government lawyer Wednesday on the precise criteria the U.S. Department of Education would use to decide who is no longer eligible.

  • June 03, 2026

    Treatment Providers Can't DQ Participants' Atty In Wage Suit

    Several Texas-based addiction recovery program operators cannot remove a worker's attorney from a proposed wage class action over his prior involvement with the programs, a federal judge found, saying the operators failed to show the attorney had a conflict of interest or was a necessary witness.

  • June 03, 2026

    Medical Equipment Co. Inks $14.3M Deal In Overbilling Suit

    Pennsylvania-based AdaptHealth Corp. will pay $14.3 million to settle claims that it violated the North Carolina Debt Collection Act by overcharging and trying to collect debts from patients who had returned medical equipment to the company, according to details of a deal released this week.

  • June 03, 2026

    Bankrupt Hospital Can't Exit $3B BCBS Antitrust Deal

    A bankrupt Alabama hospital with "settler's remorse" can't bail on a multibillion-dollar antitrust settlement with Blue Cross Blue Shield, a federal judge ruled Tuesday.

  • June 03, 2026

    Ill. Court Blocks Fla. Suit Targeting Gender Care Policies

    An Illinois federal judge blocked the Florida attorney general's lawsuit targeting medical groups' policies on youth gender-affirming care, saying there's sufficient jurisdiction over Sunshine State officials because of a potential nationwide chilling effect the enforcement action caused.

  • June 03, 2026

    Trans Youth Sue NYU Langone, DOJ To Bar Records Release

    A group of transgender minors and young adults who received gender dysphoria care at NYU Langone urged a New York federal court to bar the U.S. Department of Justice from accessing their sensitive health records through a criminal subpoena.

  • June 03, 2026

    HHS Says Bronx Facility $31M Payback Suit Filed Prematurely

    The U.S. Department of Health and Human Services says a nursing center in New York City should have pursued administrative remedies before fighting the collection of $31 million in Medicare overpayments with a lawsuit.

  • June 03, 2026

    EEOC Sues Health System Over Female Van Driver's Firing

    A Maryland healthcare system discriminated against a female driver by firing her after a wheelchair-bound nursing home resident fell from her transport van, whereas a male van driver was not disciplined after a similar episode, the U.S. Equal Employment Opportunity Commission said in a new suit.

  • June 02, 2026

    NJ Sues GEO Group Over Denial Of Detention Center Access

    New Jersey sued the owner and operator of immigration detention center Delaney Hall in state court on Tuesday, accusing the contractor of violating state law by blocking health officials from inspecting the center.

  • June 02, 2026

    NC Doctor Says 'Acquitted' Conduct Skews Sentencing

    A doctor convicted of making false statements in connection with an $11 million Medicare fraud scheme is urging a North Carolina federal court to exclude conduct she says she was acquitted of from her sentencing calculation, while the government argues she's mischaracterizing the outcome of the case. 

  • June 02, 2026

    No Surprises Act's New Rule Hands Win To Providers

    A long-awaited update to the No Surprises Act includes technical changes to dispute resolutions that attorneys say add up to a win for providers seeking to navigate a complex process.

  • June 02, 2026

    John Oliver Dodges Defamation Suit Over Medicaid Segment

    A physician highlighted in a "Last Week Tonight" segment on Medicaid who sued host John Oliver for defamation lost his case Tuesday, after a New York federal judge found the challenged statements were protected speech.

  • June 02, 2026

    3 State Drug Pricing Bills Attys Should Know

    State lawmakers continue to debate bills aimed at controlling the prices of prescription drugs. In recent weeks, high-profile bills in Illinois, Virginia and Minnesota all saw movement. Here, Law360 breaks down what attorneys need to know about these three bills. 

  • June 02, 2026

    4 Things To Know Before Feds Fight Rhode Island's 340B Law

    With the federal government's support, drug companies will try to persuade the First Circuit on Wednesday to strike down a Rhode Island law blocking them from constraining federally funded hospitals and contract pharmacies that use the 340B program. Here what you need to know about the legal battles surrounding the program ahead of the hearing.

  • June 02, 2026

    Generics Makers Tell 3rd Circ. Buyers Too Few For Class

    Two pharmaceutical companies embroiled in decadelong litigation over the alleged price-fixing of generic drugs told a Third Circuit panel on Tuesday that groups of drug buyers either didn't have the numbers necessary to support class certification or were not clearly identifiable.

  • June 02, 2026

    Nonnetwork Insurance Plans Could Spur Legal Challenges

    A new Centers for Medicare & Medicaid Services rule will bring more high-deductible, low-premium plans to the Affordable Care Act marketplace. Some legal experts believe the inclusion of insurers without provider networks may run afoul of the law. .

  • June 01, 2026

    Albertsons Had Duty To Curb Opioid Diversion, Judge Rules

    As providers of controlled substances, pharmacy giants Albertsons and Safeway had legal duties to prevent the diversion of opioid drugs, a Washington state judge ruled on Monday, though whether the companies failed to fulfill those duties will be determined at trial.

  • June 01, 2026

    DC Circ. Says Military Trans Ban Flouts Constitutional Rights

    A divided D.C. Circuit panel Monday said the Trump administration illegally banned transgender individuals from military service, then narrowed a preliminary injunction to prevent the government's exclusion of transgender people presently serving in the military but not those desiring to enlist.

  • June 01, 2026

    DOJ Says Ohio Health System Can't Duck Antitrust Case

    The U.S. Department of Justice defended its antitrust case accusing OhioHealth Corp. of blocking competition through its contracts with insurers, telling an Ohio federal court the health system is depriving consumers of lower-cost health plans.

  • June 01, 2026

    NC Biz Court Bulletin: Referee Tapped, CEO To Be Deposed

    The North Carolina Business Court rounded out May by appointing a discovery referee in a healthcare antitrust class action and ordering the deposition of a top executive in a trade secrets battle, in addition to fielding a new complaint alleging unpaid capital contributions for a captive insurance company.

Expert Analysis

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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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

    Author Photo

    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.