Policy & Compliance

  • October 27, 2026

    CVS Says Faulty Medicare Advantage Ratings Will Cost It $2B

    Insurance giant CVS Health sued the Trump administration in Georgia federal court Monday, alleging that federal quality ratings for its Medicare Advantage contracts were calculated using methods a judge rejected last year and will cost the company more than $2 billion in bonus payments and rebates in 2028.

  • October 27, 2026

    Courts Take On Lilly GLP-1 Ads, J&J Mesothelioma Trial, More

    Law360 Healthcare Authority looks at a Novo Nordisk loss in its challenge to Eli Lilly's GLP-1 advertising, an Ohio verdict in wrongful death litigation over Johnson & Johnson's talc baby powder and other legal news from the past week.

  • October 27, 2026

    Healthcare Cos. Face Tough Choices In DOJ Fraud Campaign

    A flurry of policy changes made as part of the Trump administration's anti-fraud efforts will require healthcare companies to answer complex questions around whether a violation is civil, criminal or a combination of the two.

  • October 27, 2026

    NC Health Plan, Atrium Settle Spat Over Cost-Sharing Program

    The North Carolina state health plan said on Tuesday that it will add Atrium Health to its list of in-network providers next year after a public showdown over the nonprofit health system's exclusion from the plan's new preferred provider program.

  • October 27, 2026

    3 Cases To Watch In The 340B Battles

    A program that determines prescription drug costs across the country is being hashed out in the courts. Here are three cases to watch that could have lasting effects on the program's future.

  • October 26, 2026

    Novo Can't Get 'Deceptive' Lilly GLP-1 Ads Blocked Amid Suit

    A New Jersey federal judge on Monday refused to issue an injunction blocking Eli Lilly & Co. from running ads allegedly comparing its GLP-1 drug to Novo Nordisk Inc.'s using "outdated" clinical trials and "false superiority messages," ruling that Novo Nordisk hasn't shown it would be irreparably harmed.

  • October 26, 2026

    Feds Say States Lack Standing To Sue Over HHS Vax Overhaul

    The Trump administration is again asking a California federal judge to toss a coalition of states' lawsuit challenging its decision to cut vaccine recommendations for children, arguing that the states cannot show harm that gives them standing to sue.

  • October 26, 2026

    Nomi Says HHS Shirked COVID Care Reimbursement Promise

    Utah-based Nomi Health Inc. sued the U.S. government on Friday, claiming that it failed to provide more than $200 million in promised payments for testing and vaccination services provided to uninsured Americans during the COVID-19 pandemic.

  • October 26, 2026

    Mich. Panel Backs $9.7M Negligence Verdict Against Hospital

    A Michigan appeals court declined to upend a hospital's share of a $9.7 million jury verdict for administrative negligence in its care for a woman who died while receiving emergency treatment for complications following an abdominoplasty, or "tummy tuck" procedure.

  • October 26, 2026

    Radiology Co. Strikes Deal In ESOP Fight Ahead Of Trial

    Radiology company Envision and its trustee have settled a class action claiming they brokered an inflated $163.7 million stock sale to the business' employee stock ownership plan, staving off a bench trial that was days away from kicking off, according to a Colorado federal court filing.

  • October 23, 2026

    Eli Lilly, Novo Nordisk Antitrust Suit Remains Dismissed

    A Texas federal judge has denied Strive Specialties Inc.'s bid to undo her judgment dismissing the compounding pharmacy's lawsuit that accuses Eli Lilly and Novo Nordisk of blocking competition for GLP-1 medications, saying Strive's claim that the court committed a manifest legal error was based on the company's own misunderstanding.

  • October 23, 2026

    Generics MDL Judge Won't Extend Pause Over Conflict

    A Pennsylvania federal judge refused Friday to extend a pause on the generic-drug price-fixing multidistrict litigation, eyeing setting a new trial date for the first bellwether case initially paused by a conflict with a special master that the drugmakers say now covers "the entire MDL."

  • October 23, 2026

    NC Asks 4th Circ. To Undo Atty Fees In Prison Trans Care Row

    North Carolina urged the Fourth Circuit on Friday to reverse over half a million dollars in legal fees awarded to a formerly incarcerated transgender woman alleging she was wrongly denied gender-affirming surgery at a state prison, arguing the award defies U.S. Supreme Court precedent.

  • October 23, 2026

    More Info Needed To Back Up Conduent $80M Breach Deal

    A New Jersey federal judge said a bid for preliminary approval of an $80 million settlement between data breach victims and Conduent Business Services LLC lacks the case-specific materials needed to evaluate the deal's fairness.

  • October 22, 2026

    Gilead Reaches $45M Settlement To End Kickback Claims

    The Texas Office of the Attorney General on Thursday announced that pharmaceutical company Gilead Sciences Inc. signed off on a $45 million settlement to end claims that the company ran an illegal kickback scheme in order to get prescribers to favor its medications.

  • October 22, 2026

    J&J Says Justices' Denial Backs Tossing Fee Suit At 3rd Circ.

    Johnson & Johnson told the Third Circuit Thursday that the U.S. Supreme Court's recent decision not to take up a group of executives' federal benefits dispute backed its position in an appeal from J&J workers who alleged their health plans were saddled with excessive prescription drug fees.

  • October 22, 2026

    CMS Hit With Another Broker Suit Over ACA Registration Bar

    The Centers for Medicare & Medicaid Services has been hit with another suit by health insurance brokers alleging the agency is unlawfully blocking them from registering to help individuals find Affordable Care Act marketplace coverage for plan year 2027.

  • October 22, 2026

    'Substantially Impaired' Main Topic Of Medicaid Rule Hearing

    A Massachusetts federal judge pressed the Trump administration Thursday on its argument that Congress intentionally left it with the task of defining who is considered too medically frail to comply with Medicaid work requirements set to take effect in January.

  • October 22, 2026

    Shriners Hospital System Escapes Race Bias Suit

    Shriners Hospitals for Children escaped a suit from a Black and Korean ex-employee who said she faced mistreatment for complaining that she was being held to a higher standard than other workers, with an Illinois federal judge finding a reprimand she received didn't qualify as harassment.

  • October 22, 2026

    ​​DOJ Accuses Ohio State Med School Of Race Discrimination

    The Ohio State University College of Medicine gave a leg up to Black and Hispanic student applicants in violation of civil rights law, the U.S. Department of Justice claimed, alleging the school crafted admissions policies that discounted students' academic achievements.

  • October 21, 2026

    Ill. Judge Questions Bid To Block 340B Drug Discount Law

    An Illinois federal judge seemed hesitant Wednesday to halt a state law barring drugmakers from trying to impose restrictions on pharmacies under contract with a federal drug pricing discount program, saying the state seems to be maximizing public health in an area the statute doesn't address.

  • October 21, 2026

    High Court Lets Block On Prison Gender Care Ban Stand

    The U.S. Supreme Court on Wednesday allowed federal prisons to continue to offer gender transition medical services to incarcerated people.

  • October 20, 2026

    Feds Offer Up-Front Payments For Fraud Whistleblower Tips

    The U.S. Department of Justice on Tuesday announced the creation of a whistleblower incentive program offering up-front monetary awards for tips that lead to criminal fraud charges.

  • October 20, 2026

    Medical Device Co. Beats Investors' Alleged Demand Drop Suit

    A New York federal judge has dismissed a proposed shareholder class action alleging medical device maker Integer Holdings Corp. hid plummeting demand for cardiac devices and misled investors about its overall growth, concluding that the allegations do not suggest its disclosures in 2024 and 2025 were untrue or deceptive.

  • October 20, 2026

    11th Circ. Rejects Ex-3M Worker's COVID Vax Refusal Suit

    The Eleventh Circuit on Tuesday declined to revive a Title VII religious discrimination suit by a former 3M healthcare business division employee who was terminated after refusing to get vaccinated against COVID-19 because of her beliefs, finding that her own statements show that there's no conflict between her beliefs and 3M's policy. 

Expert Analysis

  • 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.

  • Prepping Health Businesses For Sale In A Data-Driven Market

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    In a thinner market for healthcare transactions, with both regulators and buyers using artificial intelligence to inspect data in great detail, the margin for error in sellers' financials and legal diligence has narrowed, requiring more proactive compliance efforts, says Cody Dumas at FBFK Law.

  • 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.