Policy & Compliance

  • November 18, 2025

    Mass. Health Co. Settles 401(k) Suit Over Pricey Fees, Funds

    A Cambridge hospital system agreed to settle a proposed class action claiming it mismanaged its $280 million retirement plan and cost workers millions in savings by failing to reduce management fees and trim costly funds from the plan, according to a Massachusetts federal court filing.

  • November 18, 2025

    Eye Doc's Hospital Competition Lawsuit Gets NC Panel Trial

    Five years after being denied “certificate of need” application for an eye surgery center, a North Carolina doctor was in court Tuesday challenging a state law that has been on the books in some form since the Carter administration.

  • November 18, 2025

    Feds Look To 'False Certification' FCA Strategy

    Prosecutors shifted strategy in a kickback case against a biotech giant. FCA attorneys are closely watching the Regeneron case for clues on how the DOJ will establish causation in a growing number of states implicated by recent circuit court rulings.

  • November 18, 2025

    McGuireWoods Is Delaying Defamation Case, NC Justices Told

    The former CEO of a managed care organization who alleges McGuireWoods and one of its ex-partners defamed him during a press conference more than seven years ago has told North Carolina's top court not to take up the case, panning their petition as yet another stalling tactic.

  • November 18, 2025

    Massage Therapist Prevails In Fla. Health Dept. License Saga

    Florida health officials' yearslong effort to revoke a massage therapist's license resulted in a notable appeals court decision that found a licensing board wrongly disregarded an administrative law judge's findings. 

  • November 17, 2025

    DC Circ. Mulls If Gov't Can Say No To 340B Rebate Program

    The D.C. Circuit is set to decide "who's the decision-maker" in a fight brought by drugmakers over the federal government's efforts to reshape the way they do drug rebates after spending more than an hour and a half Monday morning hearing out all sides.

  • November 17, 2025

    2 Execs Found Guilty In $233M ACA Fraud Scheme

    A Florida federal jury returned a guilty verdict on Monday against a marketing company CEO and insurance brokerage executive who were accused of submitting fraudulent enrollments to fully subsidized Affordable Care Act insurance plans to get millions in commission payments from insurers.

  • November 17, 2025

    B. Braun Unit Inks $38.5M Deal To End FCA Knee Implant Case

    The U.S. Department of Justice on Monday announced a $38.5 million False Claims Act settlement with a subsidiary of German medical device giant B. Braun Melsungen AG resolving accusations it sold a knee replacement implant allegedly known to fail prematurely after surgery.

  • November 17, 2025

    2nd Circ. Questions Experts' Rejection In Tylenol Autism Suits

    A Second Circuit panel on Monday appeared skeptical of a lower-court order that barred every expert witness set to testify for families who allege that patients taking Tylenol while pregnant can cause autism or attention deficit hyperactivity disorder in their children.

  • November 17, 2025

    Hospital Inks $335K Deal To End EEOC Gender Bias Suit

    A Kentucky federal judge signed off Monday on a $335,000 settlement to end a U.S. Equal Employment Opportunity Commission suit claiming a hospital system fired its chief nursing officer after she complained that she lost a promotion due to her gender.

  • November 17, 2025

    Mass. Justices Say Panel Overstepped In Sepsis Death Suit

    Massachusetts' highest court on Monday reinstated medical malpractice claims against a nurse practitioner over a patient's sepsis death, saying a tribunal had stepped beyond its role in vetting an offer of proof by the man's widow.

  • November 17, 2025

    9th Circ. Strikes Down Trans Patients' Win In ACA Bias Case

    The Ninth Circuit upended a win Monday for patients who challenged Blue Cross Blue Shield of Illinois' administration of their employer-provided health plans containing gender-affirming care exclusions, ordering a lower court to reexamine the case in light of intervening authority from the U.S. Supreme Court.

  • November 17, 2025

    Corporate Pilot Fired For Flagging Safety Concerns, Suit Says

    The former head of aviation for an oral surgery management services company in North Carolina says he was canned because of his age and hearing disability and for allegedly reporting flight scheduling practices that he said flouted federal safety laws.

  • November 17, 2025

    No High Court Review For FDA Fast-Track Denial

    The U.S. Supreme Court on Monday said it would not consider whether federal drug regulators went astray in denying fast-track review for a digestive disorder medication being developed by Vanda Pharmaceuticals.

  • November 14, 2025

    Texas Judge Rejects Bid To Block Kenvue's $398M Dividend

    Texas can't stop the makers of Tylenol from marketing the drug as safe for children and pregnant women or halt a nearly $400 million payment to shareholders, a state court ruled on Friday, rejecting arguments by Attorney General Ken Paxton's motion.

  • November 14, 2025

    Fla. Pharmacy To Pay $17M To Settle COVID False Claims Case

    A Tampa, Florida, pharmacy has agreed to pay over $17 million to settle allegations that it knowingly filed false Medicare claims for over-the-counter COVID-19 tests that hadn't gone out to recipients.

  • November 14, 2025

    Drug Buyers Defend Class Cert. In 3rd Circ. Generics Case

    Direct purchasers and end-payers in the sprawling multidistrict litigation over alleged price-fixing of generic drugs are fighting requests from Actavis and Mylan to undo class certification in the cases, arguing to the Third Circuit that the litigation is a classic example of a class action matter.

  • November 14, 2025

    10th Circ. Sides With Rehab Facility In Bias, Retaliation Suit

    The Tenth Circuit refused Friday to reopen an occupational therapist's lawsuit claiming she was unceremoniously let go by a Kansas rehabilitation clinic for reporting a colleague's inappropriate behavior toward women, saying she couldn't revive her suit using arguments the trial court never considered.

  • November 14, 2025

    Horizon BCBS To Pay $100M To End NJ AG's Overcharge Suit

    Horizon Blue Cross Blue Shield of New Jersey has agreed to pay the state $100 million to resolve allegations that it fraudulently secured a multibillion-dollar contract to administer public employee health plans and then systematically overcharged taxpayers for years, Attorney General Matthew J. Platkin announced Friday.

  • November 13, 2025

    NC Biz Court Bulletin: Rulings Spotlight Coverage Clashes

    The North Carolina Business Court plowed into the fourth quarter with two big decisions in insurance disputes that involved $50 million in COVID-19-related losses at a chain of outlet malls, and an industrial accident at a Nucor Corp. iron plant in Louisiana.

  • November 13, 2025

    Donor Info Subpoena Chills Speech, Anti-Abortion Org Says

    An organization that operates anti-abortion pregnancy centers told the U.S. Supreme Court on Thursday that New Jersey is undermining its own subpoena power in a bid to avoid constitutional review of its request for information about the group's donors.

  • November 13, 2025

    Weight-Loss Drug MDL In Pa. Grows With 3 New Jersey Cases

    Three New Jersey cases were grouped into multidistrict litigation accusing Eli Lilly & Co. and Novo Nordisk of downplaying alleged side effects of weight loss drugs like Ozempic and Trulicity, according to a transfer order filed in Pennsylvania federal court.

  • November 13, 2025

    Claims Firms Accused Of Misleading Plaintiffs In Pharma MDL

    A Pennsylvania federal judge has been asked to slow down aggressive marketing campaigns from claims recovery firms that are accused of using false and misleading advertising to attract plaintiffs in a multidistrict litigation action against pharmaceutical companies.

  • November 12, 2025

    Valsartan Cancer Expert Blocked, Ending First Injury Trial

    What was set to be the first bellwether case in the sprawling multidistrict litigation over contaminated blood pressure medication Valsartan was decided Monday when a New Jersey federal judge excluded as "pure speculation" the plaintiff's medical expert who testified that the drug caused a patient's liver cancer.

  • November 12, 2025

    Judge Questions Cigna Site Users' Standing In Data Suit

    A Pennsylvania federal judge suggested Wednesday that she may toss a proposed class action alleging Cigna failed to safeguard private health data by tracking plan members' website usage in violation of state wiretapping and federal privacy laws, ordering the plaintiffs to demonstrate that they have standing to sue.

Expert Analysis

  • 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.

  • How Gov't Shutdown Will Affect Federal Health Agencies

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    Federal health agencies' contingency plans indicate that many major programs will remain insulated from disruption during the ongoing government shutdown, but significant policy proposals will likely be delayed and the Trump administration's emphasis on reduction-in-force plans distinguishes this shutdown from past lapses, says Miranda Franco at Holland & Knight.

  • Assessing Legal, Regulatory Hurdles Of Healthcare Offshoring

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    The offshoring of administrative, nonclinical functions has emerged as an increasingly attractive option for healthcare companies seeking to reduce costs, but this presents challenges in navigating the web of state restrictions on the access or storage of patient data outside the U.S., say attorneys at McDermott.

  • 5 Years In, COVID-19 Fraud Enforcement Landscape Is Shifting

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    As the government moves pandemic fraud enforcement from small-dollar individual prosecutions to high-value corporate cases, and billions of dollars remain unaccounted for, companies and defense attorneys must take steps now to prepare for the next five years of scrutiny, says attorney David Tarras.

  • Courts Keep Upping Standing Ante In ERISA Healthcare Suits

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    As Article III standing becomes increasingly important in litigation brought by employer-sponsored health plan members under the Employee Retirement Income Security Act, several recent cases suggest that courts are taking a more scrutinizing approach to the standing inquiry in both class actions and individual matters, say attorneys at Crowell & Moring.