Policy & Compliance

  • September 22, 2026

    HHS Economist Warns Regulation Raises Medicare Spending

    Patient and consumer choice are crucial to driving down healthcare costs, while overregulation tends to increase insurance costs and Medicare spending, the chief economist and regulatory officer of the U.S. Department of Health and Human Services told an economic conference. 

  • September 22, 2026

    8th Circ. Questions Iowa's Bid To Unblock Parts Of PBM Law

    The Eighth Circuit on Tuesday appeared skeptical of the state of Iowa's bid to have the appellate court unblock parts of its law limiting pharmacy benefit managers' power to set drug prices, with multiple judges questioning different aspects of the state's standing and federal preemption analysis.

  • September 21, 2026

    Fla. Judge Keeps Publix Autism Claims Dispute In Fed. Court

    A Florida federal judge has denied a medical services provider's bid to send its lawsuit alleging that Publix Super Markets Inc. underpaid billing claims for children's autism healthcare back to state court, saying their claims are preempted by a federal law regulating employee benefits plans. 

  • September 21, 2026

    Calif. Health Group Accuses SEIU Of 'Shakedown' In RICO Suit

    A group representing California community health clinics has accused a Service Employees International Union affiliate of violating the federal anti-racketeering law, claiming in a new lawsuit that the union places manipulative ballot initiatives before California voters and only withdraws them if the clinics concede to its demands.

  • September 21, 2026

    HHS Can Claw Back $195M In Medicaid Payments From Mich.

    A D.C. federal judge on Monday said Michigan must return almost $200 million in Medicaid payments made to two state-operated psychiatric facilities, agreeing with a finding from the U.S. Department of Health and Human Services' appeals board that the institutions did not meet federal requirements.

  • September 21, 2026

    Ex-NFL Player Gets New Trial In $328M Medicare Fraud Case

    A Texas federal judge has granted a new trial for a former NFL player convicted in a $328 million Medicare billing scheme, finding that the government presented unreliable testimony and did not identify the alleged lies the defendant used to influence physicians.

  • September 21, 2026

    Medical Orgs Target Rule On Medicaid Work 'Frailty' Exclusion

    Federal regulation implementing a statutory "medical frailty" exclusion from Medicaid work requirements violates the Administrative Procedure Act, burdens healthcare providers and threatens to cause millions of people to lose their coverage, medical groups told a Maryland federal court in a complaint.

  • September 21, 2026

    HHS Defends Move To Limit Noncitizen Medicaid Benefits

    The U.S. Department of Health and Human Services has urged a Washington federal court not to block provisions in the 2025 federal budget bill generally denying Medicaid benefits to noncitizens receiving supplemental security income, countering claims of conflicting statutory language.

  • September 18, 2026

    NJ Seeks Quick Win On TikTok's Money Transfers

    New Jersey's attorney general urged a state court Friday to find TikTok liable for operating an unlicensed money transmission business via its livestreaming service, arguing the platform receives users' money, converts it into virtual currency and ultimately pays creators in cash.

  • September 18, 2026

    Colo. Judge Mulls Sanction For Hospital In Gender Care Suit

    Transgender adolescent patients of Children's Hospital Colorado told a state judge the court must sanction the hospital for refusing to resume providing gender-affirming medical care for transgender youth patients, saying Friday that "nothing has changed" since the patients filed their January lawsuit.

  • September 18, 2026

    Disney Plan Must Cover Trans Child's Mental Health Treatment

    Disney's benefits plan must reimburse an employee for her transgender child's medical care at a residential treatment facility for major depressive disorder, suicidal ideations and instances of self-harm, after a California federal judge ruled such care was necessary, "appropriate, and not feasible at a lower level of care."

  • September 18, 2026

    Employers See Moving Targets With H-1B Fee, And New Limits

    The Trump administration on Friday ordered federal agencies to scrutinize H-1B employers that have laid off U.S. workers, adding another layer of uncertainty for employers seeking to recruit highly skilled foreign workers.

  • September 18, 2026

    Texas Pregnancy Center Shutters To End Birth Tourism Suit

    A Texas-based pregnancy center on Friday agreed to shut down to resolve allegations by state Attorney General Ken Paxton that it helped Chinese nationals give birth in the U.S. while on tourist visas so their children could obtain birthright citizenship.

  • September 18, 2026

    NJ Justices Say No To Mass Tort For No Surprises Act Suits

    The New Jersey Supreme Court has rejected an application from five health insurers to designate 160 pending cases seeking the enforcement of alleged independent dispute resolution payment determinations issued under the federal No Surprises Act as multicounty litigation.

  • September 18, 2026

    NY Surgeons Say Elevance Penalty Policy Is Anticompetitive

    A practice group for independent neurosurgeons lobbed an antitrust suit against Elevance Health Inc. in New York federal court alleging the insurer is impeding their ability to compete for patients by threatening to financially penalize and terminate in-network facilities that work with them.

  • September 18, 2026

    6th Circ. Undoes Ky. State Court Remand Of PBM Fight

    The Sixth Circuit on Friday ruled that Kentucky's lawsuit accusing pharmacy benefit managers of conspiring with drug manufacturers to increase the prescription opioid supply belongs in federal court, given the appellate court's precedential ruling from January reversing remand of another state's dispute against PBMs.

  • September 17, 2026

    Opioid MDL Judge Fears 'Chaos' If PBMs Derail 100s Of Suits

    The federal judge steering multidistrict opioid litigation is lacing into major pharmacy benefit managers for asking the Sixth Circuit to abruptly reverse a key ruling, denouncing their "spurious insinuations" about his motives and warning of disarray if they successfully break up the MDL's consolidated suits.

  • September 17, 2026

    Ore. Judge Denies HHS' Attempt To Amend Gender Care Order

    An Oregon federal judge on Thursday rejected the Trump administration's bid to narrow an earlier order that voided a policy declaration central to the government's crackdown on gender-affirming care for minors.

  • September 17, 2026

    Kennedy Taps 8 For Panel Guiding ACA Preventive Care

    Eight new members have been appointed to a key federal health task force that determines which preventive healthcare services insurers must cover, Health Secretary Robert F. Kennedy Jr. announced Thursday. 

  • September 17, 2026

    NIH Grant Terminations Violate First Amendment, Court Told

    The National Institutes of Health is violating the First Amendment by terminating research grants based on policies aimed at suppressing "disfavored" viewpoints on gender identity, climate change and a host of other topics, researchers told a California federal court in a proposed class action suit.

  • September 17, 2026

    Cole Schotz Gains Brach Eichler Health Corporate Pro In NJ

    Cole Schotz PC expanded its New Jersey office with a corporate law special counsel specializing in healthcare industry clients who joined from Brach Eichler LLC, the firm announced this week.

  • September 16, 2026

    Fecal Testing Startup Founders Reach $250K Deal With SEC

    Two founders of a now-shuttered fecal testing startup have agreed to pay $125,000 each to put to rest the U.S. Securities and Exchange Commission's allegations that they used a fraudulent insurance billing scheme to get $60 million from investors, according to an announcement made Wednesday.

  • September 16, 2026

    Express Scripts Seeks To Exit AIDS Group's Drug Rate Suit

    Express Scripts called on a Washington federal judge to toss a lawsuit accusing it of using its market power to bully the AIDS Healthcare Foundation into accepting lower reimbursement rates for life-saving drugs, contending Tuesday that the case rehashes allegations a Missouri federal court has already rejected twice.

  • September 16, 2026

    1st Circ. Seems Torn Over Health Plan Surcharge For Smokers

    A First Circuit panel appeared divided Wednesday over whether a casino company is required to refund tobacco use fees after smokers on the company's health plan complete a tobacco cessation program.

  • September 15, 2026

    8th Circ. Revives Doctor's Suit Over COVID Speech Probes

    An Eighth Circuit panel on Tuesday revived a doctor's suit seeking an order limiting a Minnesota state medical board's ability to investigate him for his public statements related to the COVID-19 pandemic, finding a district court "set the bar too high" at the dismissal stage.

Expert Analysis

  • NY Ethics Opinion Warns Attys On Qui Tam Deception

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    A recent New York State Bar Association ethics opinion cautions that counsel representing whistleblowers may not induce, supervise or facilitate a client's deceptive prefiling investigations, creating a potential vulnerability for qui tam complaints built on questionable evidence-gathering methods, say attorneys at Sidley.

  • DOJ Fraud Declination Highlights Self-Disclosure Tradeoffs

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    As exemplified by the U.S. Department of Justice's declination of charges against Campus Eye Management under its new corporate enforcement policy, self-disclosure can be an attractive option for healthcare companies navigating criminal exposure, but should be weighed against potential costs, say attorneys at Morgan Lewis.

  • What DOJ Fraud Division Rule Resolves, And What It Doesn't

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    The U.S. Department of Justice’s recently published final rule answers many outstanding questions about the newly created National Fraud Enforcement Division, but overlapping mandates could result in parallel investigations and diverging viewpoints between multiple sets of prosecutors, say attorneys at Gibson Dunn.

  • Youth Center Investigation Shows Rising Governance Scrutiny

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    A recent New Hampshire attorney general report following its investigation into the state's Sununu Youth Services Center shows how organizations serving vulnerable populations can face scrutiny of their governance, safety practices and preparedness, even when investigators find no abuse, say attorneys at Morgan Lewis.

  • Target's ERISA Win Doesn't Ax Tobacco Surcharge Questions

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    Though a Minnesota federal court's recent dismissal of a putative class action challenging Target's tobacco surcharge wellness program offers employers a defense road map, courts' differing conclusions about the Employee Retirement Income Security Act versus U.S. Department of Labor requirements leave the legal landscape unsettled, say attorneys at McGuireWoods.

  • How 'Most Favored Nation' Regime Affects Biopharma Deals

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    As M&A activity surges in the biopharma space, companies will need to account for the Trump administration's most-favored-nation pricing proposals — durable in concept, if unsettled in detail — when drafting deals, say attorneys at Gibson Dunn.

  • Where DOJ's Fraud Priorities Memo May Actually Matter

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    The U.S. Department of Justice’s recently released memo outlining priorities for its newly created fraud division will shape how cases are identified, staffed and sequenced, meaning white collar defense work must begin earlier, say David Tarras at Tarras Defense and Trevor Jones at Dynamis.

  • DOJ Healthcare Declination Offers Self-Disclosure Checklist

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    The U.S. Department of Justice's declination of criminal charges against Campus Eye Management signals that its new self-disclosure policy provides a real path for healthcare companies to avoid criminal exposure, but that path is paved with speed, transparency and operational remediation, says Jonathan Porter at Husch Blackwell.

  • Correctional Healthcare Requires Clearer Legal Standards

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    As the correctional healthcare industry increasingly faces financial instability due to litigation, the U.S. Bureau of Prisons should develop clear standards for constitutionally adequate care for incarcerated patients, says Susanne Moore at Blackstone Trial Group.

  • How Home Infusion Providers Can Adapt To Enrollment Pause

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    Recent Centers for Medicare & Medicaid Services moratoria on new enrollments of home health agencies, medical equipment companies and hospices make home infusion providers' compliance obligations more complex and ambiguous, requiring new careful consideration of specific enrollment requirements and limitations, say attorneys at Quarles & Brady.

  • AI Data Mining Is Changing FCA Enforcement

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    With False Claims Act investigations increasingly emerging from statistical anomalies identified by data miners, companies need to consider what conclusions an outsider armed with artificial intelligence might draw from public-facing data and be ready to explain any anomalies if questions arise, say attorneys at Cohen & Gresser.

  • Lessons From 5 Months Of DOJ Corporate Policy Deals

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    Recent declinations and prosecution agreements between the U.S. Department of Justice and corporations since the March unveiling of the corporate enforcement and voluntary disclosure policy provide takeaways for management considering how to respond to corporate misconduct, says Brendan Quigley at Baker Botts.

  • A New Era Of Scrutiny For China-Linked Pharma Deals

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    As Congress considers bipartisan legislation that would heighten regulatory scrutiny for life sciences deals involving Chinese biotech entities, companies should reassess the risks and due diligence requirements that will come with using heavily China-dependent pipelines, says Jen Maki at Ankura.