Policy & Compliance

  • September 30, 2026

    Independence Blue Cross Will Pay $22.5M To End FCA Case

    Pennsylvania health insurer Independence Blue Cross has agreed to pay $22.5 million to resolve allegations from the federal government that the company violated the False Claims Act by submitting inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees, the U.S. attorney's office in Philadelphia said Wednesday.

  • September 29, 2026

    Courts Rule On Bayer Vax IP Row, Lilly Drug Collab And More

    Law360 Healthcare Authority looks at an order allowing Bayer CropScience to pursue patent infringement suits against COVID-19 vaccine makers, a $90 million verdict for Eli Lilly in litigation with a clinical-stage biotech company, and other legal news from the past week.

  • September 29, 2026

    Cancer Patients Can't Get Class Status In Proton Beam Suit

    A Tennessee federal judge shot down a BlueCross BlueShield health plan member's bid for class certification in his suit claiming the insurer wrongfully denied coverage for a proton beam cancer treatment it deemed investigatory, stating the case would require too much individual math to assess each patient's potential damages.

  • September 29, 2026

    DOJ Puts FCA Target On Health Data Security Lapses

    Government contractors that fail to protect personal health information are on the radar of U.S. Department of Justice officials looking to leverage the False Claims Act, attorneys told attendees at a health law conference in Washington, D.C.

  • September 29, 2026

    FCA Bar Debates Impact Of Updated Justice Manual

    The False Claims Act bar is divided on the practical impact of recent updates to a U.S. Department of Justice policy manual. Whatever happens, the healthcare industry is particularly exposed.

  • September 28, 2026

    Calif. Expands Reproductive Care, Abortion Access

    A series of new laws in California aim to expand access to medication abortion on community college campuses, bolster veterans' access to reproductive care including abortions, and make it easier for nursing parents to access lactation support, according to an announcement made Sunday.

  • September 28, 2026

    Illinois BCBS Can't Escape $6.6M Claim Repayment Fight

    Blue Cross Blue Shield of Illinois must face a specialty pharmacy's contract suit claiming the insurer illegally failed to pay out more than $6.6 million in prescription claim reimbursements for medicines the pharmacy provided to three insureds in 2021, an Illinois federal judge ruled Monday.

  • September 28, 2026

    Newsom Signs Slate Of Bills Bolstering LGBTQ+ Protections

    California Gov. Gavin Newsom signed a slate of bills defending against what he called the Trump administration's "all-out assault on the LGBTQ community," strengthening privacy protections, providing support to discharged service members and enhancing access to medical care.

  • September 28, 2026

    Split 7th Circ. Backs Ill. County's Win In COVID Vax Bias Suit

    The Seventh Circuit in a split decision Monday affirmed a summary judgment win for Cook County, Illinois, in a former hospital pharmacist's suit alleging she was unlawfully fired after she refused a COVID-19 vaccine, with the majority holding the county proved a religious exemption would've posed undue hardship and one dissenting judge saying the case should go to a jury.

  • September 28, 2026

    Trump Asks Justices To Restore Fed. Prison Trans Care Ban

    The Trump administration urged the U.S. Supreme Court on Monday to halt a district court order barring the Bureau of Prisons from enforcing a ban on gender dysphoria care for transgender people incarcerated in BOP facilities, arguing the lower court stepped beyond its proper role. 

  • September 28, 2026

    Faith-Based Rehab Program Can't Exit Wage Suit, Court Rules

    A Texas federal court allowed a man who was ordered into a faith-based addiction recovery program to pursue wage claims against the program's operators, finding he plausibly alleged participants were treated as employees who performed substantial commercial labor without lawful pay.

  • September 25, 2026

    SEC Says Mich. Atty Tipped Family About Pharma Co. Merger

    The U.S. Securities and Exchange Commission on Friday accused a Michigan tax lawyer of insider trading, alleging he told his brother and cousin about a planned but not-yet-announced merger between Y-mAbs Therapeutics Inc. and SERB Pharmaceuticals.

  • September 25, 2026

    SEC Says Md. Woman Illegally Traded On FDA Approval Info

    The SEC accused a Maryland resident of trading on nonpublic information she received from an insider ahead of the FDA's 2023 denial of a new drug application for a depression treatment submitted by Sage Therapeutics Inc. that caused the company's shares to lose over half of their value.

  • September 25, 2026

    Mayo Clinic Strikes $50K Deal To End EEOC Vax Bias Suit

    The Mayo Clinic will pay $50,000 to resolve a U.S. Equal Employment Opportunity Commission suit claiming it threatened to fire a Pentecostal Christian security guard if he didn't get vaccinated against COVID-19 despite his religious objections.

  • September 25, 2026

    Split 6th Circ. Keeps Block On Tenn. 'Abortion Trafficking' Ban

    A split Sixth Circuit panel upheld a permanent injunction on what Tennessee calls an abortion trafficking ban, finding the law is facially overbroad and violates the First Amendment by restricting speech on access to abortions in states where that care is legal.

  • September 25, 2026

    Conn. AG Beats Dentist's Appeal In Press Release Fight

    The Connecticut attorney general and a former social services commissioner did not violate a dentist's constitutional due process or privacy rights when they issued a press release announcing the $300,000 settlement of a False Claims Act case based on Medicaid billing claims, a state appellate panel ruled Friday.

  • September 25, 2026

    COVID Testing Co.'s Ex-COO Pleads Guilty In $500M Fraud

    The former chief operating officer of a COVID-19 testing company pled guilty in Michigan federal court to a healthcare fraud conspiracy allegedly involving more than $500 million in fraudulent insurance claims for services that were not performed as billed.

  • September 25, 2026

    United, TeamHealth Settle $100M ER Billing Fraud Suit

    UnitedHealthcare and TeamHealth have agreed to resolve a $100 million alleged fraud dispute over emergency room staffing and billing, according to a filing in Tennessee federal court.

  • September 25, 2026

    Cleveland Clinic Workers Win Notice In Time-Rounding Suit

    An Ohio federal judge approved notice to a proposed collective of Cleveland Clinic workers alleging the health system's time-rounding practices resulted in overtime violations, finding the workers showed a strong likelihood that they were similarly situated.

  • September 24, 2026

    Medical School Application Fee Antitrust Claim Moves Ahead

    A D.C. federal court issued an order on Thursday trimming several claims from a class action accusing the Association of American Medical Colleges of inflating medical school application fees, but allowed one of the antitrust claims to move ahead.

  • September 24, 2026

    FDA Nom Says Vaccines Safe, Won't Call IUDs Birth Control

    President Donald Trump's nominee to lead the U.S. Food and Drug Administration faced a Senate committee Thursday morning, where she affirmed the safety of vaccines when pressed but refused to directly contradict the president's false claim that the measles vaccine could be "quite lethal," and declined to affirm that IUDs are birth control and not abortifacients.

  • September 24, 2026

    Autism Therapy Provider Fights $1M MassHealth Demand

    Massachusetts' Medicaid program conducted a flawed audit of autism therapy providers last year and then demanded recoupment of paid claims without a meaningful way to challenge the audit's findings, a national therapy provider said in a lawsuit. 

  • September 24, 2026

    Full 5th Circ. Tough On Aetna's Bid To Arbitrate Aramark Suit

    The Fifth Circuit seemed skeptical Thursday of Aetna's bid to force a health plan benefits dispute from food services giant Aramark into arbitration, with judges picking the insurer's arguments apart during an en banc rehearing.

  • September 24, 2026

    UnitedHealth Blocked From Early Appeal In NM Nurse OT Suit

    A New Mexico federal court has refused to let UnitedHealthcare seek an early appeal of a ruling allowing a nurse case manager's proposed class action to proceed despite an expired statute of limitations, finding the company mischaracterized the ruling and failed to show a genuine circuit split.

  • September 23, 2026

    Blue Shield Still Facing Therapy 'Ghost Network' Suit

    A California federal judge ruled Wednesday that Blue Shield of California must face the majority of claims brought in subscribers' proposed class action alleging the insurer maintained a "ghost network" of mental-health providers that didn't exist or accept new patients, saying the suit adequately claims contract terms were not met.

Expert Analysis

  • AG Watch: Oregon's Strategic Civil Enforcement Approach

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    Oregon Attorney General Dan Rayfield’s recent antitrust litigation activity and proposed staffing increase are the latest in a series of structural and policy changes that signal that the state Department of Justice is taking a more aggressive approach to civil enforcement, says Keturah Taylor at Cozen O'Connor.

  • A Decade Later, Escobar Is Still Shaping FCA Cases

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    The U.S. Supreme Court's decision 10 years ago in Universal Health Services v. U.S. ex rel. Escobar changed the way in which lower courts evaluate False Claims Act cases — and the ruling remains vital in nearly every FCA case filed today, say attorneys at Bradley Arant.

  • How FCA, FCPA Risks Are Shifting As Feds Pull Back

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    As the federal government continues its retreat from white collar enforcement, companies should expect False Claims Act risk to grow through private whistleblower suits and Foreign Corrupt Practices Act scrutiny to shift toward foreign prosecutors, requiring more adaptability as accountability becomes less centralized, says Temidayo Aganga-Williams at Selendy Gay.

  • Trump Admin's Agency Records Purge Tests Judicial Notice

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    While courts commonly take judicial notice of data in government websites and reports, the Trump administration's recent modification or wholesale deletion of these sources means that litigants must look elsewhere to support trial admission of this information, says Jon Gryskiewicz at Lewis Baach.

  • West Coast Health Cos. Must Brace For Federal Enforcement

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    In light of the U.S. Department of Justice's newly established West Coast strike force targeting healthcare fraud across Northern California, Arizona and Nevada, health organizations will need to prioritize knowledge, vigilance and operational discipline to reduce exposure from potentially parallel criminal and civil investigations, says Michael Beckwith at Dickinson Wright.

  • High Court's Hikma Decision Reshapes 'Skinny Label' Suits

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    The U.S. Supreme Court's decision in Hikma v. Amarin marks a significant victory for generic drug manufacturers, but rather than putting an end to so-called skinny label inducement claims, it narrows and refocuses them, say attorneys at Sterne Kessler.

  • Turning To The Courts When PBM Reform Falls Short

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    The effectiveness of state laws intended to regulate pharmacy benefit managers remains uncertain, but litigation — utilizing tried-and-true theories like breach of contract and fair dealing — offers another mechanism through which stakeholders may seek relief from PBMs, say attorneys at Reed Smith.

  • High Court's Abortion Pill Stay Reinforces Appellate Principles

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    The U.S. Supreme Court's recent order in Danco Laboratories v. Louisiana, staying a Fifth Circuit ruling that reinstated an in-person requirement for dispensing the abortion medicine mifepristone, should be seen not as a definitive ruling on reproductive rights, but as an affirmation of a more disciplined jurisdictional reality, says Daniel Nardo at Nardo & Associates.

  • Bracing For Enforcers' Growing Focus On Behavioral Health

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    While recent law enforcement scrutiny of the behavioral health industry has resulted in several settlements, indicating that more enforcement activity is on the way, organizations now have an opportunity to take proactive compliance measures, says Jeffrey Fitzgerald at Polsinelli.

  • DOJ Activity Indicates Rising Antitrust Risk For Hospitals

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    Two civil actions filed by the U.S. Department of Justice against New York-Presbyterian Hospital and OhioHealth, both alleging that the hospital systems used their market power to stifle competition, highlight the government's growing scrutiny of barriers to lower-cost insurance options, say attorneys at Freshfields.

  • Engaging With FDA's New Complete Response Letter Policy

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    A citizen petition filed with the U.S. Food and Drug Administration last month puts renewed focus on the agency's practice of releasing complete response letters in near real time, materially altering the context in which life sciences companies communicate with investors regarding regulatory developments, say attorneys at Debevoise.

  • Trump's Psychedelics EO Creates A Regulatory Collision

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    Sponsors pursuing U.S. Food and Drug Administration approval for psychedelic drug access must tackle how to generate regulatory-grade safety and efficacy data in controlled trials when President Donald Trump's recent executive order on psychedelics mandates uncontrolled access through Right to Try, say Kimberly Chew at Husch Blackwell and Odette Hauke at Odette Alina.

  • AI Regulatory Gaps May Fuel FCA Enforcement Action

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    The intersection of artificial intelligence and False Claims Act enforcement presents legal risk for government contractors across several industries, particularly in the absence of a federal regulatory framework explicitly governing its development and use, say attorneys at O’Melveny.