Policy & Compliance

  • July 15, 2026

    DC Circ. Affirms Ratings For Alignment Medicare Plans

    The D.C. Circuit sided with the Centers for Medicare & Medicaid Services regarding its decision not to discard certain unfavorable surveys for Alignment Healthcare's Medicare Advantage plans, saying there is no indication of an administrative error.

  • July 14, 2026

    Albertsons Probed On Pharmacy Compliance Staffing At Trial

    Two former Albertsons pharmacy compliance executives testified in video depositions played Tuesday before a Washington judge considering whether Albertsons failed to prevent the diversion of opioids in the state, acknowledging the nationwide compliance team consisted of just six staffers between 2015 and 2020 despite heightened scrutiny amid the opioid epidemic.

  • July 14, 2026

    3rd Circ. Revives Providers' Underpayment Suit Against Cigna

    The Third Circuit partially revived several New Jersey-based healthcare practices' Employee Retirement Income Security Act suit alleging Cigna improperly underreimbursed them for covered healthcare services provided to Cigna's subscribers, ruling Monday the plaintiffs sufficiently alleged they were underpaid for some out-of-network services when compared to their normal charges for similar services.

  • July 14, 2026

    Patent Eligibility Bill Divides Senators Over Health Costs

    Several U.S. senators expressed strong support at a hearing Tuesday for a bill aimed at expanding which inventions are eligible for patents, while others appeared to have reservations about the potential effect of the proposed changes on healthcare costs.

  • July 14, 2026

    Medical Device Co. Settles FCA Claims

    A company that sells compression devices to reduce swelling in patients with certain medical conditions will pay $551,000 to settle allegations that it obtained Medicare reimbursement with falsified medical records, the U.S. attorney's office in Massachusetts announced Tuesday.

  • July 14, 2026

    FDA Resumes Drug Denial Letters Amid Secrecy Clash

    Drugmakers are examining a new batch of drug application rejection letters released by the U.S. Food and Drug Administration this month — the first disclosure since regulators paused the releases amid industry outcry.

  • July 14, 2026

    CVS Caremark Settles Out Of FTC Suit Over Insulin Pricing

    The Federal Trade Commission reached a settlement on Tuesday with CVS Caremark that includes a number of changes to its business practices, the second deal in a case accusing the country's largest pharmacy benefit managers of inflating insulin prices through unfair rebate schemes.

  • July 14, 2026

    The Latest Medicare Star Lawsuits: What You Need To Know

    Following a win in a Georgia federal court for a health plan challenging a Medicare Advantage Star Ratings calculation, Law360 Healthcare Authority looks at a recent batch of insurer lawsuits seeking to capitalize on the ruling.

  • July 14, 2026

    1st Circ. Backs CDC Ban On Importing Dogs Under 6 Months

    The First Circuit has upheld a rule requiring all dogs imported into the U.S. to be at least six months of age, saying the federal Centers for Disease Control and Prevention had shown it was a reasonable measure to fight rabies.

  • July 14, 2026

    DOJ Asks 9th Circ. Undo Trans Health Ruling Against Premera

    The federal government has backed Premera Blue Cross in its bid at the Ninth Circuit to overturn a Washington federal court's judgment that held the insurance company's coverage policy for gender dysphoria surgery is discriminatory, arguing the decision is out of line with U.S. Supreme Court precedent.

  • July 14, 2026

    Clinics Want Medicaid Abortion Stay Lifted After Pa. Court Win

    Allegheny Reproductive Health Center and other healthcare providers on Tuesday asked a Commonwealth Court judge to unfreeze money for Medicaid-funded abortions in Pennsylvania following the court's landmark ruling that the state's coverage exclusions for such abortions were unconstitutional.

  • July 14, 2026

    Kroger Says Flimsy Claims Doom Tobacco Fee Suit

    Grocery giant Kroger urged an Ohio federal judge to toss a suit challenging the legality of an extra health plan fee it charged tobacco users, stating it complied with federal benefits law by giving workers a 90-day window each year to dodge the fee by enrolling in a wellness program.

  • July 14, 2026

    HHS Wields Checkbook To Pressure State Fraud Units

    Cutting off federal funding to Medicaid fraud units in New York and Hawaii could reshape the enforcement priorities of similar units across the country. The HHS watchdog has made clear the agency wants states to lean in on criminal Medicaid fraud cases.

  • July 14, 2026

    Amgen Colo. Win May Chill States' Push To Cap Drug Prices

    A Colorado injunction blocking a prescription drug pricing statute may have thrown a wrench into efforts in other states to limit drug costs for consumers through a new crop of state oversight boards.

  • July 13, 2026

    Albertsons, Safeway Face Trial Over Wash.'s Opioid Epidemic

    Albertsons and Safeway ignored signs of problematic opioid prescriptions in Washington for years, an attorney for the state told a Seattle judge Monday during opening statements in a bench trial over allegations that the pharmacy chains failed to prevent the diversion of opioids that fueled the state's long-running overdose crisis.

  • July 13, 2026

    2nd Circ. Says Tylenol Maker Must Face Autism, ADHD Suits

    The Second Circuit said Monday that a lower court had wrongly excluded plaintiffs experts from testifying about an alleged relationship between using Tylenol during pregnancy and autism spectrum disorder and attention-deficit/hyperactivity disorder, although the panel cautioned that the decision was not political or scientific.

  • July 13, 2026

    J&J Asks 3rd Circ. To Block Return Of Ex-Worker's Fee Claims

    Johnson & Johnson has asked the Third Circuit to keep dismissed excessive fee claims out of a proposed class action alleging the company charged employees too much for a prescription drug benefits program, arguing that the lower court correctly tossed that portion of the suit for lack of standing.

  • July 13, 2026

    Northwell Escapes Suit Over Pension Plan Conversion

    Northwell Health defeated a proposed class action alleging it hid cuts to workers' pension plans when converting to a cash-balance plan in the late 1990s, with a New York federal judge finding the hospital system adequately disclosed how the change could impact participants' benefits.

  • July 13, 2026

    Health Org. Can't Halt FTC Texas Suit Over Trans Youth Care

    A D.C. federal court declined to bar the Federal Trade Commission from pursuing a consumer protection suit in Texas against the World Professional Association for Transgender Health, finding WPATH failed to show those proceedings threatened the court's injunction of a related investigation by the FTC.

  • July 13, 2026

    Utah Health System Beats 401(k) Suit Over Stable Value Fund

    A Utah federal judge tossed a suit by workers who claimed a western U.S. health system kept an underperforming stable value fund in a retirement plan and greenlighted excessive management fees, ruling their case lacks evidence that the plan could have secured better funds and fees.

  • July 10, 2026

    JPMorgan Workers Defend ERISA Suit Over High Drug Costs

    JPMorgan employees urged a New York federal judge on Friday not to end their Employee Retirement Income Security Act suit alleging they paid too much for prescription drugs, arguing JPMorgan still has not shown that its contract with its pharmacy benefit manager was reasonable.

  • July 10, 2026

    States' Stopgap Suit Aims To Shield K-12 Mental Health Grants

    Washington and 14 other states launched a preemptive lawsuit Friday to stop the Trump administration from ending federal grants for mental health programming in public schools, seeking to preserve the funding if the U.S. Department of Education succeeds in asserting new grounds for canceling the grants in a related case.

  • July 10, 2026

    DOJ Appeals Order Shielding Trans Youth Medical Records

    The U.S. Department of Justice asked the Ninth Circuit to review a California federal court's order blocking the government from trying to identify individuals who received gender-affirming care from a Stanford Medicine hospital as minors.

  • July 10, 2026

    4 Benefits Policy Issues To Watch In 2026's 2nd Half

    The U.S. Department of Labor's work to finalize a 401(k) investment selection safe harbor and plans for a new mental health parity rule are among the top employee benefits policy issues that attorneys are watching for in the latter half of 2026. Here, Law360 looks at four that practitioners say they're keeping an eye on.

  • July 10, 2026

    DOJ Defends Nurse Wage-Fixing Conviction At 9th Circ.

    The U.S. Department of Justice urged a Ninth Circuit panel to reject a Las Vegas home nursing executive's appeal of its first-ever criminal wage-fixing conviction, defending its trial characterization of a leniency deal with a cooperating company and the inclusion of the executive's statement likening nurses to prostitutes.

Expert Analysis

  • Preparing For Congressional Investigations In A Midterm Year

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    2026 will be a consequential year for congressional oversight as the upcoming midterm elections may yield bolder investigations and more aggressive state attorneys general coalitions, so companies should consider adopting risk management measures to get ahead of potential changes, say attorneys at Morgan Lewis.

  • A Meaningful Shift In FDA's Biosimilarity Analysis

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    The U.S. Food and Drug Administration's potential pivot away from routinely requiring comparative efficacy studies for interchangeable biosimilar applications would not lower regulatory standards, but instead allow applicants to allocate resources toward establishing more probative evidence, says Theodore Thompson at Stinson.

  • Top 5 Antitrust Issues For In-House Counsel To Watch In 2026

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    With Trump administration enforcement policy having largely taken shape last year, antitrust issues that in-house counsel should have on the radar range from scrutiny of technology-assisted pricing to the return of merger remedies, say attorneys at Squire Patton.

  • 2025 Legal Milestones That Will Shape Psychedelics Sector

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    As 2025 draws to a close, psychedelic drug development stands at an inflection point, experiencing unprecedented momentum through recent sweeping regulatory changes and landmark clinical milestones, amid rapidly evolving regulatory expectations, say Odette Hauke at Odette Alina LLC and Kimberly Chew at Husch Blackwell.

  • 2025 State AI Laws Expand Liability, Raise Insurance Risks

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    As 2025 nears its end, claims professionals should be aware of trends in state legislation addressing artificial intelligence use, as insurance claims based on some of these liability-expanding statutes are a certainty, say attorneys at Wiley.

  • Learning From 2025 FCA Trends Targeting PE In Healthcare

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    False Claims Act enforcement trends and legislative developments from this year signal intensifying state and federal scrutiny of private equity's growing footprint in healthcare, and the urgency of compliance, says Lisa Re at Arnold & Porter.

  • How 11th Circ.'s Qui Tam Review Could Affect FCA Litigation

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    On Dec. 12, the Eleventh Circuit will hear arguments in U.S. ex rel. Zafirov v. Florida Medical Associates, setting the stage for a decision that could drastically reduce enforcement under the False Claims Act, and presenting an opportunity to seek U.S. Supreme Court review of the act's whistleblower provisions, say attorneys at Epstein Becker.

  • How MAHA Is Taking Shape At The State Level

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    The national spotlight on the federal government's Make America Healthy Again movement is bolstering state-level actions regarding potential health impacts of certain food ingredients, increasing the difficulty and importance of maintaining effective compliance programs, say attorneys at Cooley.

  • A Look At Middlemen Fees In 340B Drug Discount Program

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    A U.S. Senate committee's recent hearing on the Section 340B drug discount program, along with statistical analysis of payment amounts, contribute to a growing consensus that middlemen fees are too high, say William Sarraille at the University of Maryland, and Shanyue Zeng and Rory Martin at IQVIA.

  • Nursing Home Abuse Cases Face 3 Barriers That Need Reform

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    Recent headlines reveal persistent gaps in oversight and protection for vulnerable residents in long-term care, but prosecution of these cases is often stymied by numerous challenges that will require a comprehensive overhaul of regulatory, legal and financial structures to address, says Veronica Finkelstein at Wilmington University.

  • Mulling Differing Circuit Rulings On Gender-Affirming Care

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    Despite the Eleventh Circuit's recent holding in Lange v. Houston County that a health plan's exclusion for gender-affirming surgery did not violate Title VII, employers should be mindful of other court decisions suggesting that different legal challenges may still apply to blanket exclusions for such care, say attorneys at Smith Gambrell.

  • State AGs May Extend Their Reach To Nat'l Security Concerns

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    Companies with foreign supply-chain risk exposure need a comprehensive risk-management strategy to address a growing trend in which state attorneys general use broadly written state laws to target conduct that may not violate federal regulations, but arguably constitutes a national security threat, say attorneys at Wiley.

  • Unique Aspects Of Texas' Approach To AI Regulation

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    The Texas Responsible AI Governance Act — which will soon be the sole comprehensive artificial intelligence law in the U.S. — pulls threads from EU and Colorado laws but introduces more targeted rules with fewer obligations on commercial entities, say attorneys at MVA Law.