Policy & Compliance
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December 16, 2025
Hospital Owners Sue HHS Over Medicare Payment Rule
Allina Health System and other nonprofit hospital owners have sued the U.S. Department of Health and Human Services, telling a D.C. federal judge it unlawfully enacted a rule that will cause safety-net hospitals to lose out on billions of dollars of Medicare payments.
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December 16, 2025
FCA In 2025: Trump, A Qui Tam Clash And Whopping Penalties
From a 10-figure verdict to shifting Justice Department enforcement priorities, Law360 looks at the major FCA developments of the year.
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December 15, 2025
States Fight Sandoz Bid To Argue Duplication In Generics Row
Multiple attorneys general have told a Connecticut federal court that Sandoz Inc. and Fougera Pharmaceuticals Inc. can't claim the states' grievances over allegations of price fixing are duplicative of claims that were already settled, since there are some claims and forms of relief that only state plaintiffs can seek.
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December 15, 2025
DOJ Raises Accreditation Concerns In Vet School Case
The U.S. Department of Justice waded into a Tennessee veterinary school's antitrust case challenging the American Veterinary Medical Association's accreditation requirements, raising concerns about the risk posed by professional groups that play gatekeeping functions.
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December 15, 2025
NC Panel Says State's Hospital Law Is Constitutional
North Carolina's "certificate of need" law hasn't created a monopoly nor has it restricted an eye surgeon's right to earn a living, a state court panel ruled Friday, ending for now the surgeon's yearslong suit arguing the law is facially unconstitutional.
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December 15, 2025
Formula Suits An 'Undue Burden' On Cook County, Panel Says
An Illinois appellate court Friday agreed with Abbott Laboratories that 23 lawsuits alleging the company failed to warn of important risks associated with infant formulas and caused premature babies to develop necrotizing enterocolitis should not have been filed in Cook County, where the infants at the center of those cases were not born and have never lived.
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December 15, 2025
Connecticut 'Likely' To Settle Generic Drug Price Cap Dispute
A pharmaceutical industry trade group and the state of Connecticut have signaled their intent to settle a feud over the interpretation of the state's generic drug price cap law, and a federal judge gave them until Monday to say more about their plan.
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December 15, 2025
Yale Hospital Hit With $32M Baby Formula Death Verdict
A Connecticut judge has hit Yale University and Yale New Haven Hospital with a nearly $32 million verdict over the death of a premature baby, finding doctors failed to obtain either informed consent, or any consent, before feeding the infant a diet fortified by a product produced from cow's milk.
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December 15, 2025
Feds Deny Breaking Plea Deal With Ex-Morgue Manager
Prosecutors told a Pennsylvania federal judge Monday that they did not breach a plea deal between the government and Cedric Lodge by seeking a harsh sentence for the former head of Harvard University's morgue who admitted to theft and trafficking of human remains, claiming that Lodge's arguments to the contrary amounted to buyer's remorse.
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December 15, 2025
High Court Won't Review Doctor 'Upcoding' Acquittal Decision
The U.S. Supreme Court said Monday that it won't review a decision allowing a retrial of a Maryland doctor who was initially found guilty of a COVID-19 testing scheme but then secured an acquittal.
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December 12, 2025
Ore. Justices Rule Docs Can Be Liable For Nonpatient Deaths
Oregon's highest court ruled that medical professionals can be held liable if their negligence results in a nonpatient's death, settling a split between a trial and appeals court in a case over a cyclist struck and killed by a driver under the influence of prescription drugs.
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December 12, 2025
Court Nixes NY Nursing Home's Win In COVID Immunity Suit
It was premature for a trial court to find that a liability statute protected a Bronx-based nursing home from a suit over a patient's death, a New York appellate court ruled Thursday, concluding further fact inquiry is needed in the case.
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December 12, 2025
Sherwin-Williams Flicks Tobacco Fee Suit To Arbitration
An Ohio federal judge refused Friday to toss a proposed class action from two Sherwin-Williams ex-workers who alleged an employee health plan tobacco surcharge violated nondiscrimination provisions in federal benefits law, finding while one claim could proceed in court, the dispute should first head to arbitration.
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December 12, 2025
11th Circ. Scrutinizes Qui Tam History In FCA Challenge
The Eleventh Circuit Friday weighed both the history of whistleblower laws going back to the nation's founding and recent U.S. Supreme Court commentary on qui tam litigation in a closely watched challenge to the False Claims Act.
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December 11, 2025
Trial Record Backs Gender-Affirming Care, Ohio Justices Told
A group of transgender youths and their families urged Ohio's highest court to affirm their win overturning state restrictions on gender-affirming care, arguing undisputed evidence at trial backed their arguments on the safety and effectiveness of the treatment.
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December 11, 2025
6th Circ. Panel Shows No Leanings On PBM Jurisdiction Fight
A Sixth Circuit appeals panel gave few hints Thursday on whether it would send back to state court a lawsuit from Ohio alleging that pharmacy benefit managers were driving up prescription prices through rebate schemes.
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December 10, 2025
Florida, Texas Sue FDA Over Abortion Drug Approval
The states of Florida and Texas again took aim at the U.S. Food and Drug Administration's approval of abortion medication mifepristone, saying in a Tuesday suit that the agency flouted federal law in greenlighting the drug and signing off on several generic versions.
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December 10, 2025
Teva Pulls 200 Patents From Orange Book Amid FTC Probe
The Federal Trade Commission said Wednesday an investigation it conducted into Teva Pharmaceuticals prompted the company to remove over 200 patents from the U.S. Food and Drug Administration's Orange Book.
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December 10, 2025
Courts Let Military Ban Trans, HIV-Positive Troops For Now
Two federal appellate courts have cleared the federal government to enforce a pair of controversial policies restricting transgender and HIV-positive people from serving in the military, with each lifting trial court blockades on the rules while litigation challenging them plays out.
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December 10, 2025
Nursing Home Owners Defrauded Medicaid For Years, NJ Says
The owners of two New Jersey nursing homes diverted nearly $100 million in Medicaid funds to themselves while intentionally understaffing the facilities and neglecting the residents, according to a state comptroller report released Wednesday that called for more scrutiny of for-profit residential care facility operators.
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December 10, 2025
Med Delivery Co. Fired Workers For Pay Complaints, Suit Says
A pharmaceutical delivery company misclassified drivers as independent contractors even though it controlled nearly every aspect of their work and fired 12 named drivers at once for speaking up about it, according to a proposed class action filed in Kentucky federal court.
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December 10, 2025
Feds Seek 10 Years For Ex-Harvard Morgue Manager
Federal prosecutors in Pennsylvania have recommended that the court impose a 10-year prison sentence for former Harvard Medical School morgue manager Cedric Lodge following his admission to stealing and selling body parts from cadavers donated to the school for scientific research.
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December 09, 2025
Fla. AG Targets Pediatric Org. In Gender-Affirming Care Suit
The office of Florida Attorney General James Uthmeier sued the American Academy for Pediatrics along with the World Professional Association for Transgender Health and the Endocrine Society in Florida state court Tuesday for allegedly misleading the public about the safety of gender-affirming care for minors.
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December 09, 2025
Meet The Attys For Humana In Price-Fixing MDL Set For Trial
Attorneys from Lowey Dannenberg PC and Schneider Wallace Cottrell Kim LLP are teaming up to represent insurance giant Humana in the first bellwether case set for trial in multidistrict litigation accusing pharmaceutical companies of fixing generic drug prices.
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December 09, 2025
Lax Enforcement Spurs Suits Over Insurers' 'Ghost' Networks
More patients are alleging that what are known as insurers' ghost networks — directories full of unreachable providers — deny them access to mental health care. Their counsel say scarce enforcement is just one of the problems.
Expert Analysis
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AG Watch: Illinois A Key Player In State-Level Enforcement
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.
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Organ Transplant System Reforms Mark Regulatory Overhaul
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.
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Federal Grantees May Soon Face More Limitations On Speech
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.
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HHS Wound Care Report Highlights Need For Payment Reform
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.
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Assessing The Future Of The HIPAA Reproductive Health Rule
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.
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DOJ's Tracing Rule For Pandemic Loan Fraud Is Untenable
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.
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New Health AI Guidance Features A Provider-Centric Approach
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.
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Mass. Ruling May Pave New Avenue To Target Subpoenas
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.
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What To Expect After FDA Warnings To GLP-1 Compounders
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.
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How Financial Cos. Can Prep As NYDFS Cyber Changes Loom
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.
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How Courts May Interpret Data-Driven Healthcare Fraud Suits
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.
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How Gov't Shutdown Will Affect Federal Health Agencies
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.
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Assessing Legal, Regulatory Hurdles Of Healthcare Offshoring
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.