Policy & Compliance
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October 14, 2025
6th Circ. Won't Revive Allergy Tester's Antitrust Case
The Sixth Circuit refused to revive an allergy testing and treatment company's antitrust case accusing an insurer and a medical group of conspiring to squeeze it out of the market, after finding that doctors are the ones being directly harmed by the alleged activity.
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October 14, 2025
State Fraud Units Step Up To Police Medicaid
The loss of seasoned prosecutors at federal agencies, coupled with the Trump administration’s intense focus on immigration, is undermining the government’s ability to police complex healthcare fraud schemes. State Medicaid fraud units are stepping up.
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October 14, 2025
Meet HHS General Counsel Michael Stuart
Michael Stuart, a former chief federal prosecutor for West Virginia, has been confirmed by the U.S. Senate to serve as general counsel for the Department of Health and Human Services, where he has promised to make healthcare fraud enforcement a priority.
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October 14, 2025
Humana's 2025 Medicare Ratings Sound, Judge Says
A Texas federal judge on Tuesday upheld the Centers for Medicare & Medicaid Services' 2025 star ratings for some of Humana Inc.'s Medicare Advantage plans, saying the agency had the right to hand down a poor rating to the insurer.
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October 14, 2025
Expert Warns Of Autism Claims 'Tsunami' For Vax Program
Drawing on federal data on profound autism, a law professor and former Arnold & Porter partner predicts that a federal declaration that childhood vaccines cause autism could generate roughly $30 billion in new claims a year and bankrupt the National Vaccine Injury Compensation Program.
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October 14, 2025
CMS 'Upcoding' Audit Plan In Doubt After Texas Ruling
The nation's top Medicare official pledged to use a deluge of new audits to beat back "upcoding" overpayments for Medicare Advantage plans. A Texas federal judge blew a hole in the strategy recently by voiding a 2023 rule on data sample extrapolation.
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October 14, 2025
Justices Seek SG Input In 'Lightning Rod' Health Ministry Case
The U.S. Supreme Court Tuesday asked for the U.S. solicitor general to weigh in on a "lightning rod" of a case involving the regulation of nonprofit healthcare-sharing ministries that provide cheap, Christian-friendly health insurance options but aren't legally bound to pay for medical care.
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October 14, 2025
Philly Healthcare Duo Joins Burns White
Burns White LLC announced that a pair of experienced Philadelphia-based attorneys have joined the firm's healthcare practice as a member and of counsel.
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October 14, 2025
Catching Up With Delaware's Chancery Court
Last week at the Delaware Chancery Court, Vice Chancellor Lori W. Will ruled that Carlos Vasallo remains the CEO of Caribevision TV Network LLC, finding that majority investors' attempt to remove him under a defective 2019 agreement was invalid for lack of proper notice.
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October 14, 2025
H-1B Visa Fee Threatens To Deepen Doctor Shortages
A new $100,000 fee for healthcare worker visas is sowing confusion in the medical community and raising concerns that the price tag could block thousands of doctors from practicing in underserved and rural communities.
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October 10, 2025
AstraZeneca Strikes 'Most Favored Nation' Price Deal
Pharmaceutical giant AstraZeneca on Friday cut a deal with the Trump administration to reduce drug prices in the United States, agreeing to provide its medications for Medicaid beneficiaries at discount prices.
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October 10, 2025
Ex-Casino CEO's ERISA Fight Against ND Tribe Gets Trimmed
A North Dakota federal judge trimmed a suit by the ex-CEO of a tribe-owned casino who alleged his healthcare benefits were cut off following a period of leave, finding the court lacked jurisdiction over common law claims, but claims under federal benefits law were sufficiently backed up to reach discovery.
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October 09, 2025
Aetna Inks ERISA Deal Over Nixed Spinal Surgery Claims
Aetna has agreed to pay a class of health plan members up to $55,000 each to resolve their suit alleging their coverage claims for lumbar disk replacement surgeries were wrongfully denied, amounting to a deal worth millions of dollars, according to a California federal court filing.
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October 09, 2025
ADA Doesn't Stop At Prison Gates, 3rd Circ. Says In Reversal
The Third Circuit ordered a lower court to accept an incarcerated man's amended Americans with Disabilities Act lawsuit against a Pennsylvania prison that he says denied him proper medical treatment when a spinal cord injury left him paralyzed in his cell.
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October 09, 2025
San Antonio Abandons Out-Of-State Abortion Travel Appeal
The city of San Antonio on Thursday conceded defeat in its request for court approval to go forward with a program that included funding for out-of-state travel for abortions, handing a victory to the state's attorney general.
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October 08, 2025
Chancery Extends Pause On Hospital Board Law Challenge
The pause on ChristianaCare's lawsuit in Delaware Chancery Court against state officials in which it's challenging legislation that created a state-appointed board to review and approve hospital budgets was extended four months Wednesday to allow more time for the sides to reach a settlement.
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October 08, 2025
$20M Deal Over Wash. Hospital Wage Claims Gets Final OK
A Washington state judge has given the final sign-off on a $20 million deal resolving a class action alleging that the state of Washington, doing business as the University of Washington Medical Center, shortchanged healthcare workers by rounding their hours worked and denying them second meal breaks on longer shifts.
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October 08, 2025
Arnall Golden Sanctioned For Giving Feds ERISA Suit Docs
A California federal judge has ordered Arnall Golden Gregory LLP to pay a $50,000 penalty for giving the U.S. Department of Labor confidential documents United Behavioral Health turned over in a class action accusing the insurer of overcharging workers for out-of-network substance use disorder treatments.
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October 08, 2025
Trump Admin Challenges Denial Of Trans Care Subpoena
The Trump administration told a Massachusetts federal judge that he got it wrong in quashing a subpoena for records of gender-affirming care at Boston Children's Hospital last month, urging the court to reconsider.
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October 07, 2025
Aetna COVID-19 Test Provider Sues Insurer For 'Unpaid' $53M
A Nebraska company that provided COVID-19 testing for Aetna has filed suit in California federal court, alleging that the insurer owes it more than $53 million for testing services but has refused to pay up.
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October 07, 2025
Bausch And Teva Blocked Cheaper IBS Drug, Retailers Say
A slew of retailers on Tuesday accused Bausch Health Cos. Inc. and Teva Pharmaceuticals of working together to keep the generic version of an irritable bowel syndrome drug off the market until 2028, forcing the retailers and other purchasers of the drug to pay monopoly prices.
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October 07, 2025
As Shutdown Continues, Hospital Attys Face Tired Clients
As the government shutdown passes the one-week mark, hospital administrators facing potential financial hits and other heartache from the battle on Capitol Hill are getting tired.
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October 07, 2025
4th Circ. Urged To Reverse $10M Medicare Fraud Conviction
A former physician's assistant on Tuesday requested that the Fourth Circuit reverse a six-year prison sentence for his involvement in a $10 million Medicaid fraud scheme, claiming evidence that could exonerate him was suppressed by a federal district court.
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October 07, 2025
DOJ Deal In Medicare Fraud Case A 'Slap On The Wrist'
Healthcare startup Troy Medicare had big ambitions to revolutionize senior care in the Medicare Advantage market before justice officials learned that thousands of people were being fraudulently enrolled. A former Troy board member calls the company’s nonprosecution agreement a “slap on the wrist.”
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October 07, 2025
Drug Tax Outdoes Biblical Punishment, 5th Circ. Judge Says
A Fifth Circuit panel pressed the U.S. Department of Health and Human Services to justify the basis for the Medicare drug pricing program's steep excise tax, asking Tuesday whether the government had ever levied a higher tax in the nation's history.
Expert Analysis
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A Breakdown Of Trump's Order On Drug Pricing
The Trump administration may attempt to effectuate through rulemaking a recently issued executive order on lowering drug prices, which would likely have an adverse effect on stakeholders and trigger litigation, say attorneys at Debevoise.
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Takeaways From DOJ's 1st Wage-Fixing Jury Conviction
U.S. v. Lopez marked the U.S. Department of Justice's first labor market conviction at trial as a Nevada federal jury found a home healthcare staffing executive guilty of wage-fixing and wire fraud, signaling that improper agreements risk facing successful criminal prosecution, say attorneys at McGuireWoods.
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Deregulation Memo Presents Risks, Opportunities For Cos.
A recent Trump administration memo providing direction to agencies tasked with rescinding regulations under an earlier executive order — without undergoing the typical notice-and-review process — will likely create much uncertainty for businesses, though they may be able to engage with agencies to shape the regulatory agenda, say attorneys at Blank Rome.
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The IRS Shouldn't Go To War Over Harvard's Tax Exemption
If the Internal Revenue Service revokes Harvard's tax-exempt status for violating established public policy — a position unsupported by currently available information — the precedent set by surviving the inevitable court challenge could undercut the autonomy and distinctiveness of the charitable sector, says Johnny Rex Buckles at Houston Law Center.
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New Hospice Regulations Should Enforce Core Principles
As the U.S. Department of Health and Human Services' Office of Inspector General prepares to research and expand on oversight of Medicare hospice care, the OIG should keep in mind certain core principles, such as an emphasis on preventing the entry of hospices that raise red flags, says Bill Dombi at Arnall Golden.
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7 Considerations For Conducting Drug Clinical Trials Abroad
With continuing cuts to U.S. Food and Drug Administration staffing motivating some pharmaceutical companies to consider developing drugs abroad, it's important to understand the additional risks and compliance requirements associated with conducting clinical studies in other countries, say attorneys at Morgan Lewis.
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Compliance Lessons From Warby Parker's HIPAA Fine
The U.S. Department of Health and Human Services' civil money penalty against Warby Parker highlights the emerging challenges that consumer-facing brands encounter when expanding into healthcare-adjacent sectors, with Health Insurance Portability and Accountability Act compliance being a potential focus of regulatory attention, say attorneys at Saul Ewing.
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5th Circ. Ruling Is Latest Signal Of Shaky Qui Tam Landscape
In his recent concurring opinion in U.S. v. Peripheral Vascular Associates, a Fifth Circuit judge joined a growing list of jurists suggesting that the False Claims Act's whistleblower provisions are unconstitutional, underscoring that acceptance of qui tam relators can no longer be taken for granted, say attorneys at Miller & Chevalier.
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Medicare Advantage Enforcement Strong Amid Agency Cuts
The second Trump administration's actions thus far suggest that Medicare Advantage enforcement remains a bipartisan focus despite challenges presented by evolving trends in federal agency staffing and resources, say attorneys at Ropes & Gray.
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A New Tool For Assessing Kickback Risks In Health Marketing
The Seventh Circuit's recent decision in U.S. v. Sorensen, reversing a conviction after trial of a durable medical equipment distributor, highlights two principle considerations for determining whether payments to marketers in healthcare are unlawful under the Anti-Kickback Statute, says Elisha Kobre at Sheppard Mullin.
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How Trump Orders Affect Health Orgs.' Care For Trans Minors
Two recent executive orders issued by President Donald Trump regarding gender-affirming care for minors have put healthcare organizations in a precarious situation, and these institutions should prepare for various implications and potential scenarios, say attorneys at ArentFox.
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Reproductive Health Under Trump So Far, And What's Next
Based on priorities stated so far, the Trump administration will likely continue to weaken Biden-era policies that protect reproductive health, with abortion, in vitro fertilization and contraception all being issues to watch closely amid a post-Dobbs shift, say attorneys at McDermott.
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What's Next For Lab Test Regulation Without FDA Authority
A recent Texas federal court decision vacating the U.S. Food and Drug Administration's final rule that would apply FDA regulations to laboratory-developed tests signals potential positive impacts in the diagnostic space, and could inspire more healthcare entities to litigate against the government, say attorneys at Hooper Lundy.