Policy & Compliance

  • September 23, 2026

    Health Workers Win OK Of $4M Deal In Time-Rounding Suit

    Workers at an Indiana hospital network secured final approval of a $4 million settlement to resolve their claims that the company systematically shaved time from their pay through a biased rounding system, with a federal judge finding the deal fair and reasonable.

  • September 22, 2026

    Courts Rule On Doc's Prison Term, No Surprises Act And More

    Law360 Healthcare Authority looks at a First Circuit decision backing criminal penalties on a psychiatrist convicted for submitting $19 million in fraudulent claims, the Second Circuit's conclusion that the No Surprises Act doesn't provide a private right of action for enforcing independent dispute resolutions awards, and other appellate rulings affecting the healthcare industry over the last week.

  • September 22, 2026

    FDA Must Revisit MiMedx Wound Care Powder Classification

    A Georgia federal judge vacated the Food and Drug Administration's classification of biomedical company MiMedx's wound care treatment as a biological product, which carries heightened regulatory requirements, finding the agency's determination was arbitrary because it had classified similar products as devices.

  • September 22, 2026

    RI Judge Vacates Feds' Noncitizen Benefit Restrictions

    New York and other states applauded a Rhode Island federal judge's finding that the Trump administration flouted rulemaking requirements when it reinterpreted a 30-year-old welfare reform bill to try to subject a slew of federally funded benefit programs to immigration status verification requirements.

  • September 22, 2026

    Feds Cut 760K Enrollees From ACA Exchanges, Claim Fraud

    The Trump administration on Tuesday said it's kicking about 760,000 enrollees off the Affordable Care Act insurance marketplace, saying they aren't eligible for subsidies or don't exist at all.

  • September 22, 2026

    Dialysis Co., Workers Agree To Resolve 401(k) Forfeiture Suit

    Dialysis company Fresenius has agreed to resolve a proposed class action accusing it of unlawfully using forfeited 401(k) funds to cover its obligations to the plan rather than pay for the plan's administrative fees, according to a Tuesday filing in Massachusetts federal court.

  • September 22, 2026

    HHS Economist Warns Regulation Raises Medicare Spending

    Patient and consumer choice are crucial to driving down healthcare costs, while overregulation tends to increase insurance costs and Medicare spending, the chief economist and regulatory officer of the U.S. Department of Health and Human Services told an economic conference. 

  • September 22, 2026

    8th Circ. Questions Iowa's Bid To Unblock Parts Of PBM Law

    The Eighth Circuit on Tuesday appeared skeptical of the state of Iowa's bid to have the appellate court unblock parts of its law limiting pharmacy benefit managers' power to set drug prices, with multiple judges questioning different aspects of the state's standing and federal preemption analysis.

  • September 21, 2026

    Fla. Judge Keeps Publix Autism Claims Dispute In Fed. Court

    A Florida federal judge has denied a medical services provider's bid to send its lawsuit alleging that Publix Super Markets Inc. underpaid billing claims for children's autism healthcare back to state court, saying their claims are preempted by a federal law regulating employee benefits plans. 

  • September 21, 2026

    Calif. Health Group Accuses SEIU Of 'Shakedown' In RICO Suit

    A group representing California community health clinics has accused a Service Employees International Union affiliate of violating the federal anti-racketeering law, claiming in a new lawsuit that the union places manipulative ballot initiatives before California voters and only withdraws them if the clinics concede to its demands.

  • September 21, 2026

    HHS Can Claw Back $195M In Medicaid Payments From Mich.

    A D.C. federal judge on Monday said Michigan must return almost $200 million in Medicaid payments made to two state-operated psychiatric facilities, agreeing with a finding from the U.S. Department of Health and Human Services' appeals board that the institutions did not meet federal requirements.

  • September 21, 2026

    Ex-NFL Player Gets New Trial In $328M Medicare Fraud Case

    A Texas federal judge has granted a new trial for a former NFL player convicted in a $328 million Medicare billing scheme, finding that the government presented unreliable testimony and did not identify the alleged lies the defendant used to influence physicians.

  • September 21, 2026

    Medical Orgs Target Rule On Medicaid Work 'Frailty' Exclusion

    Federal regulation implementing a statutory "medical frailty" exclusion from Medicaid work requirements violates the Administrative Procedure Act, burdens healthcare providers and threatens to cause millions of people to lose their coverage, medical groups told a Maryland federal court in a complaint.

  • September 21, 2026

    HHS Defends Move To Limit Noncitizen Medicaid Benefits

    The U.S. Department of Health and Human Services has urged a Washington federal court not to block provisions in the 2025 federal budget bill generally denying Medicaid benefits to noncitizens receiving supplemental security income, countering claims of conflicting statutory language.

  • September 18, 2026

    NJ Seeks Quick Win On TikTok's Money Transfers

    New Jersey's attorney general urged a state court Friday to find TikTok liable for operating an unlicensed money transmission business via its livestreaming service, arguing the platform receives users' money, converts it into virtual currency and ultimately pays creators in cash.

  • September 18, 2026

    Colo. Judge Mulls Sanction For Hospital In Gender Care Suit

    Transgender adolescent patients of Children's Hospital Colorado told a state judge the court must sanction the hospital for refusing to resume providing gender-affirming medical care for transgender youth patients, saying Friday that "nothing has changed" since the patients filed their January lawsuit.

  • September 18, 2026

    Disney Plan Must Cover Trans Child's Mental Health Treatment

    Disney's benefits plan must reimburse an employee for her transgender child's medical care at a residential treatment facility for major depressive disorder, suicidal ideations and instances of self-harm, after a California federal judge ruled such care was necessary, "appropriate, and not feasible at a lower level of care."

  • September 18, 2026

    Employers See Moving Targets With H-1B Fee, And New Limits

    The Trump administration on Friday ordered federal agencies to scrutinize H-1B employers that have laid off U.S. workers, adding another layer of uncertainty for employers seeking to recruit highly skilled foreign workers.

  • September 18, 2026

    Texas Pregnancy Center Shutters To End Birth Tourism Suit

    A Texas-based pregnancy center on Friday agreed to shut down to resolve allegations by state Attorney General Ken Paxton that it helped Chinese nationals give birth in the U.S. while on tourist visas so their children could obtain birthright citizenship.

  • September 18, 2026

    NJ Justices Say No To Mass Tort For No Surprises Act Suits

    The New Jersey Supreme Court has rejected an application from five health insurers to designate 160 pending cases seeking the enforcement of alleged independent dispute resolution payment determinations issued under the federal No Surprises Act as multicounty litigation.

  • September 18, 2026

    NY Surgeons Say Elevance Penalty Policy Is Anticompetitive

    A practice group for independent neurosurgeons lobbed an antitrust suit against Elevance Health Inc. in New York federal court alleging the insurer is impeding their ability to compete for patients by threatening to financially penalize and terminate in-network facilities that work with them.

  • September 18, 2026

    6th Circ. Undoes Ky. State Court Remand Of PBM Fight

    The Sixth Circuit on Friday ruled that Kentucky's lawsuit accusing pharmacy benefit managers of conspiring with drug manufacturers to increase the prescription opioid supply belongs in federal court, given the appellate court's precedential ruling from January reversing remand of another state's dispute against PBMs.

  • September 17, 2026

    Opioid MDL Judge Fears 'Chaos' If PBMs Derail 100s Of Suits

    The federal judge steering multidistrict opioid litigation is lacing into major pharmacy benefit managers for asking the Sixth Circuit to abruptly reverse a key ruling, denouncing their "spurious insinuations" about his motives and warning of disarray if they successfully break up the MDL's consolidated suits.

  • September 17, 2026

    Ore. Judge Denies HHS' Attempt To Amend Gender Care Order

    An Oregon federal judge on Thursday rejected the Trump administration's bid to narrow an earlier order that voided a policy declaration central to the government's crackdown on gender-affirming care for minors.

  • September 17, 2026

    Kennedy Taps 8 For Panel Guiding ACA Preventive Care

    Eight new members have been appointed to a key federal health task force that determines which preventive healthcare services insurers must cover, Health Secretary Robert F. Kennedy Jr. announced Thursday. 

Expert Analysis

  • 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.

  • 5th Circ.'s Abortion Pill Order Is Shaky On Multiple Grounds

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    The Fifth Circuit's recent order in Louisiana v. U.S. Food and Drug Administration, reinstating an in-person dispensing requirement for the abortion medication mifepristone, seems to turn federalism upside-down, and is also questionable for several other reasons, says Gregory Curtner at Curtner Law.

  • 5 Takeaways From Justices' Subpoena Fight Ruling

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    The U.S. Supreme Court's recent decision in First Choice v. Davenport fortifies a line of First Amendment associational privacy cases stretching back nearly 70 years, and ensures that organizations subject to government demands for donor information have a meaningful federal forum in which to defend their constitutional rights, say attorneys at DLA Piper.

  • Accelerated Psychedelic Therapy Pathways Require Caution

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    President Donald Trump's new executive order aiming to accelerate the approval of psychedelic drugs for the treatment of mental health disorders will likely bolster investigational psychedelic therapies, but parties within the psychedelic product supply chain will still need to prepare for potentially burdensome compliance requirements, say attorneys at Morgan Lewis.

  • Health Cos. Must Act Quickly To Secure Digital Front Doors

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    A fast-approaching deadline will require health providers to implement digital accessibility standards to their websites, necessitating important compliance steps that will help to ensure equal access to online health services, say attorneys at Holland & Knight.

  • How Oregon Ruling Affects Federal Gender Care Crackdown

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    In a favorable development for healthcare providers, an Oregon federal court recently vacated certain U.S. Department of Health and Human Services restrictions on gender-affirming care for minors, but the government's broader campaign against this care, including proposed rulemaking and agency investigations, leaves significant uncertainty, say attorneys at Arnold & Porter.