Policy & Compliance
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November 24, 2025
Wash. Hits Regence BlueShield With Transparency Fine
Washington's insurance commissioner slapped Regence BlueShield with a $550,000 fine, the state announced Monday, for purportedly violating reporting requirements under a federal law that says health insurers must provide the same level of coverage for mental health care as general medical care.
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November 24, 2025
ND Justices Reverse Ruling That Struck Down Abortion Ban
North Dakota's near-total ban on abortion is back in effect after the state's top court narrowly reversed a lower court decision by failing to reach the supermajority required to declare the law unconstitutional.
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November 24, 2025
Hi-Tech Pharma CEO Beats Most Of Feds' Fraud Case
A Georgia federal jury acquitted Hi-Tech Pharmaceuticals' chief executive on the bulk of the conspiracy, fraud and money laundering charges leveled against him, rejecting allegations that he cheated his customers by drawing up bogus quality certificates.
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November 24, 2025
Justices Won't Review Doctor's Conviction For Reusing Devices
The U.S. Supreme Court on Monday rejected a petition from a North Carolina physician seeking to revisit the Fourth Circuit's decision to back her conviction for healthcare fraud.
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November 21, 2025
DC Judge Axes Teva Challenge To Drug Price Program
A D.C. federal judge tossed a challenge by Teva Pharmaceuticals to the Medicare drug price negotiation program, marking the latest in a series of losses by drugmakers and trade groups seeking to upend the program.
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November 21, 2025
Fla. Wound Doctor Agrees To Pay $45M For Overbilling Claims
A Florida doctor and his companies agreed to pay $45 million to settle a suit alleging he submitted fraudulent claims to Medicare for medically unnecessary wound care procedures, the U.S. government said Friday.
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November 21, 2025
Colo. Healthcare System Stiffing Workers, Court Told
A pair of former workers for a hospital and healthcare facility operator in Colorado have accused their past employer of routinely shortchanging their pay in violation of state and federal wage and hour laws, according to a proposed class action filed in federal court.
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November 21, 2025
PBMs Say Gov't Benefits From Drug Rebates FTC Condemns
Caremark Rx, Express Scripts and OptumRx have been given permission to seek documents they say will show the government benefits from the same type of prescription drug rebating activity that's being targeted by the Federal Trade Commission's insulin pricing case.
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November 21, 2025
'No Evidence' New Info Backs J&J Unit's Libel Suit, Court Told
A doctor being sued by Johnson & Johnson's bankrupt talc subsidiary pushed back on the unit's bid to revive its trade libel claim over a scientific article she wrote linking asbestos in talc to mesothelioma, arguing it failed to cite any evidence that undermines the court's finding that the article was a nonactionable statement of scientific opinion.
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November 21, 2025
Rothman Orthopaedics Hit With Pa. Wiretapping Lawsuit
Rothman Orthopaedics has been hit with a proposed class action in Pennsylvania alleging the company violated state wiretapping laws by intercepting private healthcare information on its website using a third-party tracking pixel.
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November 21, 2025
Hyperbaric Chamber Death Suit Not Covered, Insurers Say
Two Nationwide insurers said they have no duty to defend or indemnify a hyperbaric oxygen therapy center or its employees in a suit over the death of a 5-year-old boy, telling a Michigan federal court that there was no bodily injury or property damage caused by an occurrence, or accident.
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November 21, 2025
1st Circ. Clears IT Co. In Suit Over Zoll Patient Data Breach
An information technology company cannot be held liable for a data breach exposing the health information of patients of a unit of medical device maker Zoll Medical Corp, the First Circuit ruled, because the two companies did not have a business relationship permitting them to hold one responsible for another's conduct.
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November 20, 2025
Pharma Cos. Seek Early Win In States' Price-Fixing Lawsuit
A collection of states failed to prove an overarching conspiracy among 25 separate pharmaceutical companies to fix the prices of generic drugs, most of them dermatology formulations, the drugmakers argued Wednesday in support of a bid for an early win on one element of dozens of antitrust claims.
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November 20, 2025
5th Circ. Seeks Interpretation Of Miss. Health Decisions Law
A Fifth Circuit panel asked the Mississippi Supreme Court on Thursday to clarify an "ambiguous" state law that sets out which family members can act as surrogates and make healthcare decisions for relatives without the capacity to decide for themselves.
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November 20, 2025
Ala. County Must Face Inmate Death Claim, 11th Circ. Rules
An Eleventh Circuit panel ruled Thursday that no Alabama state law prevents a county from facing liability for an incarcerated person's death after substandard healthcare from a third-party medical provider the county hired.
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November 20, 2025
Blue Shield Of California, Magellan Sued Over 'Ghost Network'
Blue Shield of California and Magellan Health maintain a "ghost network" directory of mental health providers who don't exist or don't accept new patients, leading customers to hit a dead end or desperately resort to expensive out-of-network providers, according to a proposed class action filed Wednesday in California federal court.
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November 20, 2025
10th Circ. Weighs Colo. Law On Healthcare Sharing Plans
A Tenth Circuit panel grappled Thursday with how the court should interpret a Colorado law requiring entities not authorized to offer insurance in the state to report certain information about their healthcare sharing plans, in an appeal by a religious trade group challenging the law's constitutionality.
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November 20, 2025
Claims Firms Barred From Misleading Plaintiffs In Pharma MDL
On the same day that a Philadelphia federal judge approved $58 million in settlements as part of an ongoing generic-drug price-fixing multidistrict litigation, she also ordered several claims recovery firms to correct allegedly false and misleading ads used to attract potential clients seeking to make claims on the settlements.
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November 19, 2025
Senior Living Co. Inks $7.2M Deal To End Wash. AG's Probe
Oregon-based senior living provider Bonaventure will invest $7 million in staffing and upgrades and shell out $200,000 in resident credits to resolve allegations of substandard care at 10 Washington state facilities, under a settlement filed Wednesday.
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November 19, 2025
Is 'Red Book' Best For Drug Pricing? Pa. Justices Ask
The Pennsylvania Supreme Court seemed skeptical Wednesday that the state workers' compensation authorities were using the best guide to calculate pharmacy reimbursements for injured workers' prescription drugs, with the justices questioning the fairness of the industry's long-used "red book" method.
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November 19, 2025
11th Circ. Backs Kaiser In Air Ambulance Arbitration Dispute
The Eleventh Circuit on Wednesday declined an air ambulance company's bid to scrap an arbitrator's ruling that Kaiser only owes $24,000 for an emergency helicopter flight, rejecting the emergency medical provider's arguments that the insurer committed fraud by strategically lowballing the arbitrator.
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November 19, 2025
Aetna Gets OK For $3.4M Deal In Cancer Treatment Denial Suit
A Florida federal judge has signed off on Aetna's $3.4 million settlement agreement resolving a class action that alleged the insurer unlawfully mischaracterized a proton beam cancer radiation treatment as experimental to deny dozens of claims.
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November 19, 2025
Senate GOP Resists Extending Expanded ACA Tax Premiums
Senate Finance Committee Democrats on Wednesday urged their Republican counterparts to extend the enhanced tax credits for the Affordable Care Act, which is set to expire at the end of the year, but Republicans said they were looking for other options to address rising healthcare costs.
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November 19, 2025
Conn. Dentists Pay $714K To Settle Patient Kickback Claims
Two Connecticut dentists will pay more than $714,000 to the state and federal governments to settle joint allegations that their practices submitted false government benefits claims that contained kickbacks for patient recruiters.
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November 19, 2025
Pa. Health Network's $1.15M 401(k) Suit Deal Gets Initial OK
A healthcare system Wednesday secured initial approval from a Pennsylvania federal court for a $1.15 million settlement agreement that would resolve a proposed class action alleging the company misused forfeited retirement plan funds and allowed the plan's administrative costs to soar.
Expert Analysis
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Previewing State Efforts To Regulate Mental Health Chatbots
New York, Nevada and Utah have all recently enacted laws regulating the use of artificial intelligence to deliver mental health services, offering early insights into how other states may regulate this area, say attorneys at Goodwin.
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How DOJ's New Data Security Rules Leave HIPAA In The Dust
The U.S. Department of Justice's recently effective data security requirements carry profound implications for how healthcare providers collect, store, share and use data — and approach vendor oversight — that go far beyond the Health Insurance Portability and Accountability Act, say attorneys at Nelson Mullins.
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Texas Med Spas Must Prepare For 2 New State Laws
Two new laws in Texas — regulating elective intravenous therapy and reforming healthcare noncompetes — mark a pivotal shift in the regulatory framework for medical spas in the state, which must proactively adapt their operations and contractual practices, says Brad Cook at Munsch Hardt.
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DOJ-HHS Collab Crystallizes Focus On Health Enforcement
The recently announced partnership between the U.S. Department of Justice and U.S. Department of Health and Human Services to combat False Claims Act violations, following a multiyear trend of high-dollar DOJ recoveries, signals a long-term enforcement horizon with major implications for healthcare entities and whistleblowers, say attorneys at RJO.
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How The Healthline Privacy Settlement Redefines Ad Tech Use
The Healthline settlement is the first time California has drawn a clear line in the sand around how website tracking must function in practice, so if your site uses tracking technologies, especially around sensitive content like health or finance, regulators are inspecting your website's back end, not just its banner, say attorneys at Baker Donelson.
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How Sweeping Budget Bill Shakes Up Health Industry
With the recently passed One Big Beautiful Bill Act marking one of the most significant overhauls of federal health policy since the passage of the Affordable Care Act, providers, managed care organizations and life sciences companies must now shift focus from policy review to implementation planning, say advisers at Holland & Knight.
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New DOJ Penalty Policy Could Spell Trouble For Cos.
In light of the U.S. Department of Justice’s recently published guidance making victim relief a core condition of coordinated resolution crediting, companies facing parallel investigations must carefully calibrate their negotiation strategies to minimize the risk of duplicative penalties, say attorneys at Debevoise.
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A Look At Key 5th Circ. White Collar Rulings So Far This Year
In the first half of 2025, the Fifth Circuit has decided numerous cases of particular import to white collar practitioners, which collectively underscore the critical importance of meticulous recordbuilding, procedural compliance and strategic litigation choices at every stage of a case, says Joe Magliolo at Jackson Walker.
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What US Medicine Onshoring Means For Indian Life Sciences
Despite the Trump administration's latest moves to onshore essential medicine manufacturing, India will likely remain an indispensable component of the U.S. drug supply chain, but Indian manufacturers should prepare for stricter compliance checks, says Jashaswi Ghosh at Holon Law Partners.
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FCA Working Group Reboot Signals EHR Compliance Risk
The revival of the False Claims Act working group is an aggressive expansion of enforcement efforts by the Justice Department and the U.S. Department of Health and Human Services targeted toward technology-enabled fraud involving electronic health records and other data, say attorneys at ArentFox Schiff.
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FDA's Hasty Policymaking Approach Faces APA Challenges
Though the U.S. Food and Drug Administration has abandoned its usual notice-and-comment process for implementing new regulatory initiatives, two recent district court decisions make clear that these programs are still susceptible to Administrative Procedure Act challenges, says Rachel Turow at Skadden.
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The Metamorphosis Of The Major Questions Doctrine
The so-called major questions doctrine arose as a counterweight to Chevron deference over the past few decades, but invocations of the doctrine have persisted in the year since Chevron was overturned, suggesting it still has a role to play in reining in agency overreach, say attorneys at Crowell & Moring.
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A Rapidly Evolving Landscape For Noncompetes In Healthcare
A wave of new state laws regulating noncompete agreements in the healthcare sector, varying in scope, approach and enforceability, are shaped by several factors unique to the industry and are likely to distort the market, say attorneys at Seyfarth.