Policy & Compliance

  • March 31, 2026

    As FCA Meets 340B, Geyser Of Qui Tam Suits May Erupt

    A Ninth Circuit ruling on the intersection of two of the most contentious laws in healthcare may be a combustible mix that triggers a new wave of fraud litigation.

  • March 31, 2026

    Insurer Says Yale Was 'Misleading' In $4.1M Transplant Claim

    A Liberty Mutual unit accused Yale University's health system of making "serious and material misstatements" about a plan member's bone marrow transplant, the insurer said in its answer and counterclaim for a declaratory judgment that it can continue to deny the $4.1 million claim.

  • March 31, 2026

    Justices Reject Colorado's LGBTQ+ 'Conversion' Ban

    The U.S. Supreme Court ruled Tuesday that a Colorado ban on therapy intended to change a minor's sexual orientation or gender identity amounts to viewpoint discrimination against a Christian therapist, a finding that split the court's liberal wing and crossed ideological lines.

  • March 30, 2026

    Don't Set Special IP Rules For 'Skinny Labels,' Justices Told

    Drugmakers, industry groups, hospitals and scholars have urged the U.S. Supreme Court to uphold a decision letting a patent suit proceed over a generic drug using a so-called skinny label, saying the generics company is seeking unwarranted special protections that would upend patent law.

  • March 30, 2026

    FCA Qui Tams Are Unconstitutional, Eli Lilly Tells Justices

    The False Claims Act's whistleblower provisions are unconstitutional, drugmaker Eli Lilly has told the U.S. Supreme Court, asking it to overturn a Seventh Circuit decision upholding a $183 million trial win for a whistleblower who claimed the drug company hid how much it charged for Medicaid-covered drugs. 

  • March 30, 2026

    FTC Says Anesthesia Group Cheered While Raising Prices

    The Federal Trade Commission pushed back against a bid from U.S. Anesthesia Partners to avoid facing trial on claims that it monopolized the market through a rollup strategy, saying the company celebrated its ability to dramatically increase prices.

  • March 27, 2026

    5th Circ. Won't Revive Ex-Health IT Co. Worker's Bias Suit

    The Fifth Circuit upheld a healthcare information technology provider's win over a Black former manager's lawsuit claiming she was fired for complaining that a white male colleague was treated better, saying she couldn't overcome the company's rationale for letting her go.

  • March 27, 2026

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

    A Pennsylvania federal judge gave the green light to a $1.15 million deal resolving a proposed class action alleging a healthcare system misused workers' forfeited employee retirement plan funds and failed to rein in administrative fees.

  • March 27, 2026

    Insurer Rips Sanctions Bid In Opioid Coverage Dispute

    An insurer asked an Illinois federal court to reject a drug wholesaler's bid for sanctions in a dispute over coverage for underlying opioid litigation, saying the accusations that it intentionally destroyed pertinent evidence are, "at best, based on half-truths and misstatements of fact."

  • March 27, 2026

    Hospital Escapes Ex-Workers' 401(k) Forfeiture, Fund Suit

    A New York federal judge on Friday tossed a proposed class action against a healthcare company alleging mismanagement of an employee 401(k) plan, concluding that ex-workers who sued lacked standing to bring some claims while the remaining allegations weren't sufficiently backed up to state a claim for violating federal benefits law.

  • March 26, 2026

    Elanco Beats Investor Suit Over Dog Drug's Reg Challenges

    A Maryland federal judge Thursday dismissed a proposed securities class action against Elanco Animal Health Inc. that claimed the animal pharmaceuticals company misled investors about the safety of a canine dermatitis treatment it was developing and its timeline for the medication's commercial launch.

  • March 26, 2026

    DOJ Says NY-Presbyterian Blocked Lower-Cost Health Plans

    New York-Presbyterian Hospital is forcing major health insurers to contract with it on an "all-or-nothing" basis, which is driving up healthcare costs in New York City and violates federal antitrust law, the U.S. Department of Justice said in a federal lawsuit filed Thursday. 

  • March 25, 2026

    AbbVie, Novartis Sue Wash. Over New 340B Drug-Pricing Law

    Pharmaceutical giants Novartis and AbbVie say a new Washington state law illegally expands drugmakers' obligations to provide deeply discounted medications under the federal government's 340B Drug Pricing Program, according to a pair of legal challenges launched in federal court on Wednesday.

  • March 25, 2026

    3rd Circ. Probes Free Speech Impact Of NJ Telemedicine Law

    A Third Circuit panel on Wednesday examined whether New Jersey can bar out-of-state doctors from consulting with Garden State patients via phone or video without a state license, pressing both sides on where to draw the line between protected speech and the regulated practice of medicine.

  • March 25, 2026

    Insurers, Brokers Can't Exit Medicare Advantage Steering Suit

    A Massachusetts federal judge on Wednesday largely rejected a bid by insurers and brokers to toss claims that they colluded in a kickback scheme to steer Medicare Advantage customers to certain companies and to push away disabled individuals.

  • March 25, 2026

    PBMs Say Mich. Price-Fixing Suit Lacks Specifics

    For the second time, pharmacy benefit managers Express Scripts Inc. and Prime Therapeutics LLC asked a Michigan federal judge on Monday to toss a price-fixing suit filed by Michigan Attorney General Dana Nessel, arguing that the state has no standing to file the suit.

  • March 25, 2026

    Judge Trims SEC Fraud Case Over Cancer Drug Claims

    A Massachusetts federal judge greenlighted U.S. Securities and Exchange Commission claims against two of three former pharmaceutical executives accused of concealing from investors the U.S. Food and Drug Administration's "harsh critiques" about a cancer drug.

  • March 25, 2026

    Foreign Aides' RICO Labor Suit Against PruittHealth Hits NC

    A Tennessee federal judge has agreed to transfer to North Carolina a year-old class action in which foreign workers say a healthcare system and recruiter trapped them in punitive contracts and buried them in grueling labor, after a judge said the action could have been filed in the Tar Heel State in the first place.

  • March 24, 2026

    Nicotine Pouch Maker To Refile FDA Suit In DC After Transfer

    The maker and seller of Zone nicotine pouches on Tuesday dismissed its own lawsuit accusing the U.S. Food and Drug Administration of unfairly holding up a market application for its product, promising to refile in D.C. federal court after a Texas federal court transferred it to South Carolina federal court.

  • March 24, 2026

    Biz Services Co. Faces ERISA Suit Over 'Tobacco Surcharge'

    Business services company Conduent unlawfully imposes health insurance surcharges on employees who use tobacco products, forcing them to pay more for coverage the company provides, a former employee and plan participant said in a proposed class action in New Jersey federal court.

  • March 24, 2026

    $5.7M Cigna Ghost Network Deal Receives Final Go-Ahead

    An Illinois federal judge gave his final sign-off Tuesday to a $5.7 million settlement in what he called an "interesting" case accusing Cigna of improperly advertising out-of-network providers as though they're in-network for certain benefit plans it administered.

  • March 24, 2026

    Health Co. Escapes Workers' 401(k) Forfeiture Suit In La.

    A Louisiana federal judge agreed to toss a federal benefits lawsuit against a health company from workers who alleged the company misspent forfeitures from their employee 401(k) plan, rejecting the workers' argument that funds should have gone toward defraying expenses instead of lowering employer-side contribution obligations.

  • March 24, 2026

    Utah Hospitals To Track Violence As States Step Up Reporting

    Under a new law, Utah hospitals will join a national effort to better understand the risks facing healthcare workers.

  • March 24, 2026

    Ohio Justices Likely Split On Trans Care Restrictions

    The Ohio Supreme Court appeared split Tuesday as to whether a new state law banning gender-affirming care for minors trumps a decade-old healthcare freedom provision passed by voters that says state laws can't block a patient from obtaining healthcare. 

  • March 24, 2026

    Fraud Task Force May Boost White Collar Defense Work

    A new federal anti-fraud task force involving at least a dozen federal agencies could soon expose more state and local governments, contractors, companies and others to compliance risks, particularly in healthcare fraud and False Claims Act cases, experts say.

Expert Analysis

  • Trans Care Enforcement Landscape Is Evolving Quickly

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    The recent coordinated federal effort to reshape pediatric gender-affirming care through enforcement and funding pressure has created a rapidly evolving regulatory environment marked by shifting risk assessments and potential downstream market effects for healthcare institutions and life sciences companies, say attorneys at Arnall Golden.

  • 11th Circ. May Bring Tectonic Shift To FCA Qui Tam Actions

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    The Eleventh Circuit's upcoming decision in Zafirov v. Florida Medical Associates, assessing whether the False Claims Act permits ordinary citizens to stand as officers of the federal government, could significantly limit private relators' ability to bring FCA actions, say attorneys at Saul Ewing.

  • To Survive FCA Actions, Small Cos. Must Take Offensive Steps

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    A fumbled response to False Claims Act allegations can doom lower-middle-market businesses, and with FCA enforcement hitting record levels for two years, smaller companies must have offensive strategies ready that focus their limited resources on defeating civil qui tam and federal criminal actions, says Derrelle Janey at Olshan Frome.

  • Record FCA Recoveries Signal Intensified Healthcare Focus

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    In its recently released False Claims Act statistics, the U.S. government's emphasis on record healthcare recoveries and government-initiated healthcare matters last year indicates robust enforcement ahead, though the administration's focus on current policy objectives also extends beyond the healthcare sector, say attorneys at Epstein Becker.

  • A Potential Shift In FDA's Approach To Drug Trial Design

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    Recent guidance released by the U.S. Food and Drug Administration clarifying how Bayesian approaches — which combine prior knowledge with new data — may be used in clinical trials reflects the agency's continued interest in innovative trial designs that may accelerate drug approvals, say attorneys at Alston & Bird.

  • What FDA Guidance Means For Future Of Health Software

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    Two significant final guidance documents released by the U.S. Food and Drug Administration last month reflect a targeted effort to ease innovation friction around specific areas, including singular clinical decision support recommendations and sensor-based wearables, while maintaining established regulatory boundaries, say attorneys at Covington.

  • How State FCA Activity May Affect Civil Fraud Enforcement

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    A growing trend of state attorneys general enforcing their False Claims Act analogues independently of the U.S. Department of Justice carries potential repercussions for civil fraud enforcement and qui tam litigation considerations, say Li Yu at Bernstein Litowitz, Ellen London at London & Naor and Gwen Stamper at Vogel Slade.

  • Wage-Based H-1B Rule Amplifies Lottery Risks For Law Firms

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    Under the wage-based H-1B lottery rule taking effect Feb. 27, law firms planning to hire noncitizen law graduates awaiting bar admission should consider their options, as the work performed by such candidates may sit at the intersection of multiple occupational classifications with differing chances of success, says Jun Li at Reid & Wise.

  • Assessing Compliance Risks Around TrumpRx Participation

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    As there are novel compliance obligations and potential political opposition related to the new TrumpRx online drug platform, companies intending to participate on the site should consider the pressure points that are likely to draw enforcement scrutiny, say attorneys at Sheppard.

  • Predicting Actual Impact From CDC's New Vaccine Guidance

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    Recent federal changes to the childhood immunization schedule, reducing the number of vaccine recommendations from 18 to 11, do not automatically create enforceable obligations for parents, schools or healthcare providers, but may spur litigation and other downstream effects on school policies and state guidelines, says Mehdi Sinaki at Michelman & Robinson.

  • What Rescheduling Means For Cannabis Labels, Marketing

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    The proposed reclassification of cannabis is expected to bring heightened scrutiny of labeling, advertising and marketing from the U.S. Food and Drug Administration and the Federal Trade Commission, but the brands that tighten evidence, standardize operations and professionalize marketing controls now will see fewer surprises and better outcomes, say attorneys at Wilson Elser.

  • What's At Stake In Possible Circuit Split On Medicaid Rule

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    A recent Eleventh Circuit decision, reviving Florida's lawsuit against a federal rule that reduces Medicaid funding based on agreements between hospitals, sets up a potential circuit split with the Fifth Circuit, with important ramifications for states looking to private administrators to run provider tax programs, say Liz Goodman, Karuna Seshasai and Rebecca Pitt at FTI Consulting.

  • Courts' Rare Quash Of DOJ Subpoenas Has Lessons For Cos.

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    In a rare move, three federal courts recently quashed or partially quashed expansive U.S. Department of Justice administrative subpoenas issued to providers of gender-affirming care, demonstrating that courts will scrutinize purpose, cabin statutory authority and acknowledge the profound privacy burdens of overbroad government demands for sensitive records, say attorneys at ArentFox Schiff.