Policy & Compliance

  • November 19, 2025

    11th Circ. Backs Kaiser In Air Ambulance Arbitration Dispute

    The Eleventh Circuit on Wednesday declined an air ambulance company's bid to scrap an arbitrator's ruling that Kaiser only owes $24,000 for an emergency helicopter flight, rejecting the emergency medical provider's arguments that the insurer committed fraud by strategically lowballing the arbitrator.

  • November 19, 2025

    Aetna Gets OK For $3.4M Deal In Cancer Treatment Denial Suit

    A Florida federal judge has signed off on Aetna's $3.4 million settlement agreement resolving a class action that alleged the insurer unlawfully mischaracterized a proton beam cancer radiation treatment as experimental to deny dozens of claims.

  • November 19, 2025

    Senate GOP Resists Extending Expanded ACA Tax Premiums

    Senate Finance Committee Democrats on Wednesday urged their Republican counterparts to extend the enhanced tax credits for the Affordable Care Act, which is set to expire at the end of the year, but Republicans said they were looking for other options to address rising healthcare costs.

  • November 19, 2025

    Conn. Dentists Pay $714K To Settle Patient Kickback Claims

    Two Connecticut dentists will pay more than $714,000 to the state and federal governments to settle joint allegations that their practices submitted false government benefits claims that contained kickbacks for patient recruiters.

  • November 19, 2025

    Pa. Health Network's $1.15M 401(k) Suit Deal Gets Initial OK

    A healthcare system Wednesday secured initial approval from a Pennsylvania federal court for a $1.15 million settlement agreement that would resolve a proposed class action alleging the company misused forfeited retirement plan funds and allowed the plan's administrative costs to soar.

  • November 19, 2025

    Whoop Blood Pressure Tracker Hit With False Ad Suit

    A consumer on Tuesday hit health and wellness wearable tech company Whoop Inc. with a proposed class action in California federal court alleging that its boasting of the blood pressure features of its fitness tracker duped consumers and prompted a warning from health regulators.

  • November 19, 2025

    Hospice Co. Should Face Tobacco Fee Suit, Judge Says

    A hospice and home healthcare provider shouldn't escape a proposed class action challenging a tobacco surcharge in its employee health plan, a Pennsylvania federal judge recommended, finding that allegations sufficiently backed up that a wellness program implementing the fee didn't meet all regulatory requirements.

  • November 19, 2025

    Doctor, Husband Admit $16M Healthcare Fraud, Tax Evasion

    A physician and her husband admitted to committing more than $16 million in healthcare fraud and tax evasion as part of a scheme that injected sick patients with the wrong medications or dosages, according to their plea agreements in Alaska federal court.

  • November 19, 2025

    COVID-19 Testing Co. Settles Wage Suit With Testers, Drivers

    A COVID-19 mobile testing company told a New York federal court that it has reached a settlement with a group of testers and drivers who claimed they were not paid full wages and overtime.

  • November 19, 2025

    Doc Takes Plea, Avoids Prison In Novel Opioid Death Case

    A retired Massachusetts doctor pled guilty and was sentenced to five years of probation in a first-of-its-kind involuntary manslaughter case over a patient's 2016 opioid overdose death, the state attorney general's office announced.

  • November 18, 2025

    Health Co. Execs Convicted In $100M Adderall Sales Scheme

    A San Francisco federal jury weighing a first-of-its-kind case on Tuesday convicted two digital healthcare company executives of scheming to sell Adderall through deceptive advertising, allegedly bringing in $100 million in illicit profits.

  • November 18, 2025

    'Surrender' Note Warrants Med Mal Retrial, Ill. Justices Hear

    A below-the-knee amputee who lost his medical malpractice trial urged the Illinois Supreme Court to order a retrial in his case Tuesday, arguing a note stating a juror sided with the defense simply to end deliberations proves the verdict was not unanimous.

  • November 18, 2025

    Severe SC Abortion Bill Falters in Committee

    A South Carolina bill that would have further criminalized abortion and subjected patients and doctors to up to 30 years in prison failed to advance out of a Senate committee on Tuesday, with antiabortion committee members raising concerns that the bill went too far.

  • November 18, 2025

    Feds Say Hi-Tech 'Trampled' Trust At Close Of Fraud Trial

    Federal prosecutors closed out a nearly monthlong fraud trial against Hi-Tech Pharmaceuticals and its longtime CEO by telling a Georgia jury Tuesday that they "proudly" stood by what defense attorneys for the supplement manufacturer and distributor previously derided as a "paper case."

  • November 18, 2025

    Bristol-Myers Squibb Can Appeal Pension Suit To 2nd Circ.

    Drugmaker Bristol-Myers Squibb and its investment manager can ask the Second Circuit to review a decision from September denying their motion to dismiss a pension dispute for lack of standing, a New York federal judge ruled.

  • November 18, 2025

    1st Circ. May Nix Trump Funding Freeze In 'Weird' Case

    The First Circuit on Tuesday hinted that a federal judge may have been in bounds when blocking the Trump administration from withholding certain funds for states, expressing skepticism that the judge's order was improper or overly broad.

  • 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.

Expert Analysis

  • 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.

  • 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.