Policy & Compliance
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August 21, 2025
CVS, Drugmakers Illegally Inflated Insulin Prices, City Claims
Drugmakers Eli Lilly and Co., Novo Nordisk Inc. and Sanofi-Aventis US LLC, pharmacy benefit managers CVS Caremark, Express Scripts and Optum Rx, and others have been hit with civil racketeering and state unfair trade practices law claims by the city of Torrington, Connecticut, over an alleged scheme to inflate insulin prices.
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August 21, 2025
DOJ Gets Backing In Fight Over Public Benefits
A group that fights to restrict immigration into the U.S. is urging a Rhode Island federal court to let the Trump administration narrow noncitizens' access to programs like Head Start, homeless shelters and food banks, arguing Thursday that a coalition of 20 states is trying to obstruct immigration enforcement and give benefits to "illegal aliens."
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August 21, 2025
High Court Allows Trump Admin To Cancel $783M In NIH Grants
The U.S. Supreme Court on Thursday allowed the Trump administration to resume the mass termination of scientific grants, overturning rulings by lower courts that had kept the funds flowing to universities and other recipients.
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August 21, 2025
Feds Claim Fla. Billing Co. Aided $15M Medicare Fraud
The U.S. government urged a Florida federal judge to deny an outsourcing company's motion to toss a $15 million False Claims Act lawsuit, saying the business aided a Miami-based laboratory to fraudulently bill Medicare for genetic tests that weren't used to treat patients.
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August 21, 2025
11th Circ. Backs Health System In Black Worker's Bias Suit
The Eleventh Circuit ruled Thursday that a fired Black worker can't revive her race and disability bias suit against a Georgia health system, saying her failure to provide a proposed date to return from medical time off amounted to an unreasonable request for indefinite leave.
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August 21, 2025
Seton Hall Gets COVID-19 Death Suit Tossed For Good
A New Jersey federal judge wasn't swayed by new arguments brought by parents of a Seton Hall University sophomore who died during a COVID-19 isolation period, saying their contract-related claims failed to establish one existed at all.
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August 21, 2025
Employer Plans In Limbo As Courts Grapple With Trans Care
Despite appellate courts' apparent willingness to allow states to ban gender-affirming care for minors, employers are still waiting for clarity on whether federal anti-discrimination laws require health plans to cover transgender healthcare access, experts say.
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August 20, 2025
17 States, DC Urge FDA To Lift Mifepristone Restrictions
Seventeen states and the District of Columbia Wednesday joined four others in urging the U.S. Food and Drug Administration to lift restrictions on the abortion drug mifepristone, saying that data their health departments collected overwhelmingly back the drug's safety.
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August 20, 2025
Judge Grills Feds On Upending 30-Year Noncitizen Benefits
A Rhode Island federal judge seemed perplexed Wednesday by a government attorney's contention that for nearly 30 years, various administrations across the political spectrum have wrongly interpreted a law the Trump administration now says requires immigration status checks for additional federal benefits.
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August 20, 2025
Ohio Justices Free Bank From $77M Guaranty Disclosure Duty
The Ohio Supreme Court on Wednesday ruled that nothing in state law required Huntington Bank to inform a co-signer of a $77 million loan guaranty about the risks associated with signing the deal with two other partners, one of whom later pled guilty to a check-kiting scheme.
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August 20, 2025
Northwell Health Inks $2.75M Deal In 403(B) Suit
New York healthcare giant Northwell Health Inc. has agreed to pay $2.75 million to end a former employee's claims it breached its fiduciary duties to participants and beneficiaries in its retirement plan by allegedly saddling workers with excessive recordkeeping fees and offering an underperforming fund.
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August 20, 2025
TikTok Can't Dodge NC Claims Over Addictive App Design
Chinese internet behemoth ByteDance Inc. and its social media subsidiary TikTok Inc. can be sued in the Tar Heel State, North Carolina's business court ruled Tuesday, preserving a lawsuit that accuses the companies of exploiting minors through addictive app design.
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August 20, 2025
NC's Cap On Med Mal Damages Is Constitutional, Panel Rules
The North Carolina state appeals court ruled Wednesday that a state law capping compensatory damages in certain medical malpractice lawsuits at $500,000 is constitutional, handing a defeat to a woman seeking to recoup her full $7.5 million jury verdict stemming from the loss of her unborn baby.
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August 20, 2025
Texas AG Threatens Suit Over Orgs. Mailing Abortion Pills
Texas Attorney General Ken Paxton has sent cease-and-desist letters to three organizations he's accused of shipping abortion drugs to women in the state in violation of state and federal laws.
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August 20, 2025
State AGs Sidelined From Sandoz Price-Fixing Deal
A group of over 40 states and territories cannot intervene in a $275 million settlement resolving generic-drug price-fixing claims against Sandoz because they only have a nominal interest in the suit that fails to confer standing, a Pennsylvania federal judge said.
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August 20, 2025
$2.8B BCBS Antitrust Deal Approved With $759M For Attys
An Alabama federal judge has approved a $2.8 billion settlement between Blue Cross Blue Shield and a class of medical providers in a landmark antitrust case, with $759 million going to Whatley Kallas LLP and other law firms for attorney fees and costs.
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August 20, 2025
Insurers Say Gov't Misusing FCA To Get Medicare Cost Cap
Insurers accused of paying brokers to steer customers to their Medicare Advantage plans asked a Massachusetts federal judge to dismiss a False Claims Act lawsuit, saying the government is mischaracterizing legal payments for marketing as kickbacks in an attempt to impose caps it has thus far been unable to obtain.
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August 20, 2025
CVS PBM Overbilling Judgment Trebled To $289M
A Pennsylvania federal judge has increased threefold a judgment against CVS Caremark from $95 million to $289 million for overbilling Medicare Part D-sponsored drugs.
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August 19, 2025
Tenn. Judge Trims Healthcare Contract TRAP Suit
A Tennessee federal judge dismissed Fair Labor Standards Act claims brought by operating room technicians claiming their ex-employer, SpecialtyCare, unlawfully required them to repay tens of thousands of dollars for specialty training, plus interest, if they quit within three years, but the judge greenlit their Truth in Lending Act claims.
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August 19, 2025
Losses Mount For Medicare Drug Negotiation Challengers
Big Pharma's losses in challenges to Medicare drug price negotiations are piling up. But don't think the industry is ready to wave the white flag.
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August 19, 2025
High Court Interest In Health Sharing Ministry Case
The U.S. Supreme Court is showing interest in a challenge to state regulatory authority over health care sharing ministries. The nonprofit groups, which offer a cheaper alternative to traditional insurance, are expected to see more demand under major changes coming to the insurance marketplace.
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August 19, 2025
Novo Nordisk Gets Forfeiture Claims Cut From 401(k) Suit
A New Jersey federal judge on Tuesday dismissed workers' allegations that Novo Nordisk unlawfully used forfeited funds in its $2.3 billion 401(k) plan for its own benefit and kept a shoddy fund on its investment roster, leaving an excessive fee claim in play.
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August 19, 2025
Panel Weighs Ga. High Court Ruling In Sham Donor Suit
Customers who accused a sperm bank of selling sperm without disclosing the true medical and criminal histories of donors urged the Georgia Court of Appeals to revive their lawsuits Tuesday, arguing the dismissals were based on a misreading of a 2020 decision from the state's high court.
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August 19, 2025
CMS Defeats 'Hair's Breadth' Star Rating Challenge
Insurance companies challenging the "star" system for rating Medicare Advantage organizations have lost another round in court, with a Texas federal judge saying Elevance Health failed to show federal officials violated the law when rounding down scores.
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August 19, 2025
Judge Backs Deal To Overhaul NY Kids' Mental Healthcare
A New York federal judge has given the green light to allow the state to revamp its Medicaid mental health services for children to expand greater in-home and crisis care to prevent the institutionalization of kids.

Trump's 'Abnormal' Use Of FCA Could Get Tricky In Court
The Trump administration is wielding the False Claims Act in unusually narrow ways to drive policies on social and cultural issues — including gender-affirming care and diversity, equity and inclusion programs — but the government's potential theories of liability under the federal law remain largely untested and might not hold up in court, experts say.

Religious Liberty Claims Spread In Abortion Ban Challenges
With the U.S. Supreme Court expanding religious protections, a groundswell of lawsuits challenging state abortion bans on free-exercise grounds has emerged.

'Shocked' By Eye-Watering Fines, Fed. Judges Redo FCA Math
District courts handling big-dollar False Claims Act cases are increasingly wrestling with the Eighth Amendment ban on excessive fines as more defendants go to trial and face whopping jury verdicts. An order last month in a New York case reducing an FCA penalty was the third of its kind in 18 months.
Expert Analysis
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The Future Of Lab-Test Regs After FDA Rescinds Rule
The U.S. Food and Drug Administration recently rescinded its laboratory-developed tests rule in response to a Texas federal court decision this spring, reinforcing a separation of authority between the FDA and the Centers for Medicare & Medicaid Services, and calling into question the FDA's role in overseeing such tests without congressional action, say attorneys at Venable.
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Unpacking Ore. Law's Limits On PE Healthcare Investment
A recent Oregon law imposes significant restrictions on nonphysicians owning or controlling medical practices, but newly enacted amendments provide some additional flexibility in certain ownership arrangements without scuttling the law's intent of addressing concerns about the rise of private equity investment in healthcare, say attorneys at Debevoise.
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Criminal Healthcare Fraud Takeaways From 4th Circ. Reversal
After the Fourth Circuit reversed a doctor’s postconviction acquittal in U.S. v. Elfenbein last month, defense attorneys should consider three strategies when handling complex criminal healthcare matters, says Jonathan Porter at Husch Blackwell.
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AG Watch: Texas Embraces The MAHA Movement
Attorneys at Kelley Drye examine Texas Attorney General Ken Paxton's actions related to the federal Make America Healthy Again movement, and how these actions hinge on representations or omissions by the target companies as opposed to specific analyses of the potential health risks.
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How States Are Regulating Health Insurers' AI Usage
The absence of a federal artificial intelligence framework positions states as key regulators of health insurers’ AI use, making it important for payors and service providers to understand the range of state AI legislation being passed in California and elsewhere, and consider implementing an AI-focused compliance infrastructure, say attorneys at Ropes & Gray.
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HHS Plan To Cut Immigrant Benefits Spurs Provider Questions
A recent notice from the U.S. Department of Health and Human Services identifying new federal public benefit programs for which nonqualified aliens are not eligible may have a major impact on entities that participate in these programs — but many questions remain unanswered, say attorneys at Foley.
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Noncompete Forecast Shows Tough Weather For Employers
Several new state noncompete laws signal rough conditions for employers, particularly in the healthcare sector, so employers must account for employees' geographic circumstances as they cannot rely solely on choice-of-law clauses, say lawyers at McDermott.
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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.