Policy & Compliance

  • October 08, 2026

    Texas Clinics Settle False COVID-19 Billing Claims For $20M

    Two Texas clinics under the same ownership have agreed to pay the government $20 million to settle False Claims Act allegations that they lied about COVID-19 billing, according to the U.S. Department of Justice.

  • October 08, 2026

    High Court Urged To Keep Prison Trans Care Ban Blocked

    The U.S. Supreme Court should decline the Trump administration's request to disturb a district court order barring the Federal Bureau of Prisons from enforcing a gender dysphoria care ban, a group of transgender individuals incarcerated in BOP facilities argued Thursday.

  • October 08, 2026

    New Fraud Division Flexes Might In Latest Enforcement Policy

    The National Fraud Enforcement Division's new corporate enforcement policy emphasizes the quick pursuit of certain types of fraud through data analysis and staff resources, expands the target list beyond traditional healthcare providers and highlights the division's growing dominance within the U.S. Department of Justice, experts say.

  • October 07, 2026

    Blue Cross Must Justify Carve-Up Unit By Unit In Calif.

    Counsel for hospital plaintiffs touted a "landmark" win in California state court litigation that will require the Blue Cross Blue Shield network to justify unit by unit how it has carved up markets.

  • October 07, 2026

    Eldercare Co.'s Wage Class Fight Bound For Wash. High Court

    Washington's highest court agreed Tuesday to take up whether an appellate panel rightly revived two workers' proposed wage-and-hour class action against an eldercare provider despite the plaintiffs' membership in a separate class action against the company that was previously settled.

  • October 07, 2026

    PhRMA Sues To Block Medicare Foreign Drug Price Rule

    The pharmaceutical industry's top lobbying group asked a D.C. federal judge Wednesday to block a new Medicare rule tying Part B drug payments to prices abroad, claiming that the U.S. Department of Health and Human Services is imposing a "most-favored-nation" price control that Congress has repeatedly declined to enact.

  • October 07, 2026

    BCBS Unit Owes Awards Under No Surprises Act, Court Told

    A Blue Cross Blue Shield unit failed to pay thousands of dollars in awards that an air ambulance company won through the No Surprises Act's arbitration process for out-of-network services rendered to the insurer's beneficiaries, the company alleges in a suit in West Virginia federal court.

  • October 07, 2026

    Mich. Judge Questions Push To Revive Abortion Restrictions

    A Michigan judge Wednesday called a state law requiring medical providers to give parenting information and a picture of a fetus to patients seeking an abortion a "hindrance" that is out of step with a voter-approved right to reproductive freedom.

  • October 06, 2026

    AstraZeneca Takes Drug-Pricing Law Challenge To 4th Circ.

    AstraZeneca on Monday asked the Fourth Circuit to resurrect its suit challenging how the Centers for Medicare & Medicaid Services determines which drugs are subject to the landmark drug-pricing program, arguing that CMS is dodging limits on how many drugs can be selected by grouping some together.

  • October 06, 2026

    CVS Can't Get Second Shot At Tossing Investors' AI Use Suit

    A New York federal judge on Tuesday declined to give CVS another opportunity to dismiss a lawsuit accusing it of inflating its revenues through the use of artificial intelligence. 

  • October 06, 2026

    Courts On Health Insurer Antitrust Row, Opioid MDL And More

    Law360 Healthcare Authority looks at the U.S. Supreme Court's request for the federal government to weigh in on an allergy company's antitrust case, a Sixth Circuit decision overturning a ruling that allowed hundreds of opioid claims against two large pharmacy benefit managers, and other legal news from the past week.

  • October 06, 2026

    1st Circ. Sees Gaps In Order Halting RFK's Vaccine Advisers

    A First Circuit panel on Tuesday puzzled over aspects of a lower court's order staying Health and Human Services Secretary Robert F. Kennedy Jr.'s appointments to a vaccine policy committee, with one judge saying he can't tell what authority the order was based on.

  • October 06, 2026

    Anthem BCBS Accused Of Failing To Reimburse 7 Hospitals

    Anthem Blue Cross and Blue Shield is facing claims in Georgia federal court filed by acute care hospitals in six states alleging the insurer failed to cover claims at agreed-upon rates and denied claims for reasons not allowed by their contracts.

  • October 06, 2026

    What To Know About Challenge To Utah Constitutional Court

    A Utah abortion rights group says the state's attempt to transfer its abortion ban challenge to a newly created court tasked with hearing constitutional challenges is forbidden. 

  • October 06, 2026

    Hospitals Face New Reality Of Medicaid Coverage Cuts

    The first tranche of cuts to Medicaid took effect this month, booting certain categories of lawfully present immigrants. Hospitals are bracing for the bigger cuts to come.

  • October 06, 2026

    FDA Accuses 10 Retailers Of Selling Unapproved STI Meds

    Federal regulators have accused Amazon, Walmart and other online retailers of selling unapproved drugs to treat herpes and other sexually transmitted infections, according to warning letters disclosed to the public Tuesday.

  • October 06, 2026

    La. Abortion Pill Suit A Stretch For Nuisance Laws

    A lawsuit led by Louisiana officials targeting those sending abortion pills across state lines is a novel — and likely difficult — new approach to public nuisance law.

  • October 06, 2026

    7th Circ. Judge Hints Precedent Dooms Worker's Vax Fight

    A Seventh Circuit judge appeared disinclined Tuesday to restart a religious discrimination suit brought by a hospital pharmacy technician who was fired for refusing to get the COVID-19 vaccine, emphasizing that the same employer's recent win in a similar appeal is "binding authority."

  • October 05, 2026

    Air Ambulance Co. Says Pilot's 'Inattention' Wasn't Willful

    A pilot's actions in the cockpit during a patient transport flight that crashed in the mountains of North Carolina don't rise to the level of gross negligence or warrant punitive damages, an operator of air ambulance helicopters said in seeking to purge those claims from a personal injury suit.

  • October 05, 2026

    Boston Health Worker Says Firing Followed Fraud Concerns

    A former program director in Boston's health department says he was fired after refusing to enroll new clients until his concerns about fraud in a home visiting program were addressed, according to a lawsuit filed in Massachusetts state court.

  • October 05, 2026

    5th Circ. Hints CMS Medicare Advantage Rule May Violate APA

    A Fifth Circuit panel seemed hesitant to buy an argument that a rule from the Centers for Medicare & Medicaid Services dealing with Medicare Advantage plan overpayments went through proper rulemaking steps, asking Monday if the agency's argument that it can change its rationale "upends" rulemaking procedures.

  • October 05, 2026

    Securities Roundup: 7 Rulings You May Have Missed

    Federal judges from California to New York and several states in between issued a slew of decisions last week that determined the fates of shareholder lawsuits against a major health insurer, a New York bank that nearly failed in 2024 and a diagnostic company accused of hiding its challenges as COVID testing demand ebbed. 

  • October 05, 2026

    Catholic Org. Funding Cut Wasn't About Faith, Mich. Says

    A Catholic charity is improperly attempting to insert a prior religious liberty case over Michigan's foster care policies into current litigation challenging the charity's de-designation as a provider of treatment for substance use disorder, state officials have argued in a brief seeking dismissal.

  • October 05, 2026

    High Court Won't Review Medical Tape Antitrust Case

    The U.S. Supreme Court refused Monday to review a case accusing medical supplies group purchasing giant Vizient Inc. of locking in hospital customers, after the lower courts found a medical tape supplier failed to define a market that Vizient allegedly monopolized.

  • October 05, 2026

    1st Circ. Doubts Harvard Grant Fight Belongs In Claims Court

    The First Circuit Monday appeared skeptical that a lower court erred in backing Harvard University in a suit over the Trump administration's bid to freeze more than $2 billion in grant funding, suggesting that the case had been decided in the proper venue.

Expert Analysis

  • FCA Ruling May Open Door To Redacting Defendants' Names

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    A recent Florida federal court decision may signal a shift from the long-prevailing view that False Claims Act defendants' identities must always be revealed when qui tam actions are unsealed, potentially providing important protection for healthcare fraud defendants who may face career consequences from unproven allegations, say attorneys at Holland & Knight.

  • New CMS Medical Device Pathway May Have Limited Effect

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    The Centers for Medicare & Medicaid Services' new pathway for giving Medicare beneficiaries earlier access to certain medical devices bears similarities to previous programs that did not advance coverage significantly, and thus may only benefit certain manufacturers, say attorneys at King & Spalding.

  • A Road Map To Modernizing Clinical Lab Regulations

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    The Centers for Medicare & Medicaid Services' recent request for comments on potential changes to the Clinical Laboratory Improvement Amendments provides an early indication of where CLIA is headed, and the operational, compliance, reimbursement and enforcement issues those changes will create, says Jose Vela at Clark Hill.

  • 2nd Circ. Tylenol MDL Ruling Clarifies Court Gatekeeper Role

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    The Second Circuit’s recent decision in multidistrict litigation over alleged links between Tylenol and developmental disorders, holding that the trial court improperly excluded expert witnesses, preserves meaningful judicial gatekeeping while making clear that judges may not resolve legitimate scientific disputes themselves, say attorneys at Lowenstein Sandler.

  • CMS Rule, DOJ Probes Deepen Gender Care Compliance Risk

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    The Centers for Medicare & Medicaid Services' final rule restricting Medicaid funding for hospitals that provide gender-affirming care is likely to face immediate litigation, but the CMS rulemaking is already working alongside U.S. Department of Justice's enforcement campaign to create operational risk for providers, say attorneys at Arnall Golden.

  • 5th Circ. Ruling Hints At Loper Bright's Effect On OSHA Suits

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    The Fifth Circuit's recent decision in Exxon Mobil v. Occupational Safety and Health Review Commission relied on Loper Bright to narrow the scope of illnesses that employers must record, signaling that courts may continue to scrutinize agency assertions that deference is due, say attorneys at Ogletree.

  • 2 Cases Shed Light On Invoking The 5th Before Congress

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    Given the anticipated increase in congressional investigations following the midterm elections, those who anticipate being in Congress' spotlight can draw valuable Fifth Amendment lessons from the ongoing case involving Dr. Anthony Fauci's testimony and the D.C. Circuit’s recent ruling in de la Torre v. Cassidy, say attorneys at King & Spalding.

  • Vanda Ruling Offers New Guide To Generic Labeling Disputes

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    The D.C. Circuit's recent decision in Vanda Pharmaceuticals v. U.S. Food and Drug Administration is significant for its guidance on when generic-drug labeling remains sufficiently similar to brand labeling and when a difference requires a statutory exception, says Shashank Upadhye at Upadhye Tang.

  • Cannabis, Psychedelics Boom Raises IP Hurdles

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    Recent data regarding patent filing activity and litigation in the cannabis and psychedelics markets indicates that as commercial interest accelerates, the scope of publicly accessible prior art is also expanding, setting a higher bar for novelty and nonobviousness in patent applications, say attorneys at Sterne Kessler.

  • 5 Practice Tips After DOJ's Healthcare Fraud Declination

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    In light of the U.S. Department of Justice's decision to not prosecute Campus Eye Management under the agency's new corporate enforcement and voluntary self-disclosure policy, healthcare companies should keep several considerations in mind when weighing their risk and self-disclosure strategy, including the distinctions between reporting to the DOJ versus other government agencies, say attorneys at Haynes Boone.

  • FDA Closeout Letter Suggests Relaxing Stance On Wearables

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    The U.S. Food and Drug Administration's recent decision not to pursue enforcement action against Whoop's wearable blood pressure tracker, read together with guidance released earlier this year, suggests a softer shift in the FDA's approach to regulating wearables, say attorneys at Arnold & Porter.

  • Teva MDL Loss Shows DPAs Can Return To Haunt Civil Suits

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    Teva’s recent partial summary judgment loss in antitrust multidistrict litigation reinforces the importance of carefully scrutinizing any statement of facts a company admits to in a deferred prosecution agreement, and illustrates the potential costs of resolving a criminal investigation this way, say attorneys at Sheppard.

  • 11th Circ. FCA Qui Tam Revival Queues Up Next Challenges

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    Though the Eleventh Circuit on Sept. 1 upheld the constitutionality of the False Claims Act's qui tam provision, it will probably face continued litigation since the appellate court declined to rule on other constitutional challenges and the decision will likely be petitioned to the U.S. Supreme Court, say attorneys at Sheppard.