Policy & Compliance

  • November 24, 2025

    Teamsters Health Plan Wants Data Breach Suit Tossed

    A Massachusetts federal judge should toss a proposed class action accusing a Teamsters healthcare plan of failing to protect plan participants' personal information, the plan argued, seeking dismissal of a suit that seeks to hold the plan liable for an August data breach.

  • November 24, 2025

    Mass. Judge Says States Can Fight Planned Parenthood Cuts

    A Massachusetts federal judge on Monday chided a Trump administration lawyer for continuing to argue that a coalition of states lacks standing to seek to block what it says is the effective defunding of Planned Parenthood, even as it only just received a lengthy list of new requirements for Medicaid reimbursement.

  • November 24, 2025

    Mich. Christian Health Group Claims Right To Deny Trans Care

    A Christian health system urged a federal court to permanently prohibit Michigan from enforcing a state civil rights law barring discrimination based on sexual orientation and gender identity, arguing the statute unconstitutionally hampers its ability to make faith-based hiring and policy decisions.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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. 

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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. 

  • 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. 

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

Expert Analysis

  • Deregulation Memo Presents Risks, Opportunities For Cos.

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    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.

  • The IRS Shouldn't Go To War Over Harvard's Tax Exemption

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    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.

  • New Hospice Regulations Should Enforce Core Principles

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    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.

  • 7 Considerations For Conducting Drug Clinical Trials Abroad

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    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.

  • Compliance Lessons From Warby Parker's HIPAA Fine

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    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.

  • 5th Circ. Ruling Is Latest Signal Of Shaky Qui Tam Landscape

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    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.

  • Medicare Advantage Enforcement Strong Amid Agency Cuts

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    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.

  • A New Tool For Assessing Kickback Risks In Health Marketing

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    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.

  • How Trump Orders Affect Health Orgs.' Care For Trans Minors

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    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.

  • Reproductive Health Under Trump So Far, And What's Next

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    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.

  • What's Next For Lab Test Regulation Without FDA Authority

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    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.

  • 6 Criteria Can Help Assess Executive Branch Actions

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    With new executive policy changes announced seemingly every day, several questions can help courts, policymakers and businesses determine whether such actions are proper, effective and in keeping with our democratic norms, say Marc Levin and Khalil Cumberbatch at the Council on Criminal Justice.

  • Learning From COVID-19 Enforcement Against Nursing Homes

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    Five years after the COVID-19 outbreak caused a high number of deaths in nursing homes, an examination of enforcement actions against nursing homes in New York and elsewhere in the country highlights obstacles that may arise when bringing cases of this type, and ways to overcome them, says Kenneth Levine at Stone & Magnanini.