Policy & Compliance

  • 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.

  • 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.

  • August 20, 2025

    CVS PBM Overbilling Judgment Trebled To $290M

    A Pennsylvania federal judge has increased threefold a judgment against CVS Caremark from $95 million to $290 million for overbilling Medicare Part D-sponsored drugs.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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. 

  • August 19, 2025

    Hawaii Abortion Drug Fight: 3 Things To Know

    The drug mifepristone has emerged as a key flash point in legal battles over state abortion restrictions, drug prescribing rules and the legalities of sending abortion medications across state lines. This week, a federal court in Hawaii will hear arguments in a challenge to the FDA's changes to the drug safety review process.

  • August 19, 2025

    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.

  • August 18, 2025

    Most Ozempic, Wegovy Claims Survive MDL Dismissal Bid

    Eli Lilly & Co. and Novo Nordisk will have to face most of a multidistrict litigation accusing them of misleading consumers over the risks and benefits of popular weight loss drugs like Ozempic and Trulicity, after a Pennsylvania federal judge only trimmed a few of the dozen claims the drugmakers tried to have tossed.

  • August 18, 2025

    Judge Known For Nixing ACA To Lead Texas' Northern District

    A conservative judge known for declaring Obamacare unconstitutional, among other high-profile rulings, took over as chief judge of the U.S. District Court for the Northern District of Texas on Monday, according to an announcement from the court.

  • August 15, 2025

    DOJ Backs Small Biz In Gender Dysphoria Coverage Dispute

    The U.S. Department of Justice told a New Hampshire federal court Friday that employers are not required under federal anti-discrimination laws to provide medical coverage for gender dysphoria, and that federal religious freedom law protects a turbomachinery company from covering a transgender employee's treatment for the disorder.

  • August 15, 2025

    Microsoft Unit Agrees To Pay $8.5M In MOVEIt Hack MDL

    A Massachusetts federal judge has preliminarily signed off on an $8.5 million settlement reached between Nuance Communications and more than 1 million patients in multidistrict litigation over a 2023 malware attack that exploited a vulnerability in Progress Software's MOVEIt transfer file tool. 

  • August 15, 2025

    Wholesalers Want Final OK For $51M AstraZeneca Settlement

    Drug wholesalers asked a Delaware federal judge Thursday for the final stamp of approval on a combined $51.4 million in settlements AstraZeneca Pharmaceuticals LP and Handa Pharmaceuticals LLC agreed to pay to resolve allegations AstraZeneca paid off generic-drug makers, including Handa, to protect its brand antipsychotic Seroquel XR.

  • August 15, 2025

    AbbVie's Key RICO Claims In Drug Cost Fraud Suit Survive

    An Illinois federal judge on Friday ruled that AbbVie could move ahead with the bulk of its racketeering, tortious interference and fraud claims against a behind-the-scenes healthcare company that the drugmaker alleges colluded with pharmacy benefit managers to fraudulently obtain drugs meant for patients in AbbVie's charitable programs.

  • August 15, 2025

    Home Chain Got OT Math Wrong For 1,000 Nurses, Court Told

    A group of nursing homes operating as one company left shift differentials and bonus pay out of certified nursing assistants' overtime math, a former employee alleged in a suit in Mississippi federal court, saying the violations affected more than 1,000 workers.

  • August 15, 2025

    1st Wrongful Death Suit Filed In Deadly Mass. Rest Home Fire

    The first of what are expected to be multiple wrongful death lawsuits stemming from a July 13 fire that killed 10 elderly and disabled residents of a Fall River, Massachusetts, assisted living facility was filed late Thursday in state court.

  • August 14, 2025

    OptumRx Flags Email Accidentally Sent To Opioid MDL Parties

    UnitedHealth subsidiary OptumRx Inc. is seeking a ban on secret communications with the Ohio federal judge overseeing sprawling national opioid litigation after the court-appointed special master accidentally sent the company an email, intended for the judge, celebrating a "gambit" that prevented objections to his decision.

  • August 14, 2025

    Calif. Justices Say No Arb. For Nursing Home Death Claim

    The California Supreme Court on Thursday reversed a decision sending to arbitration a wrongful death claim by parents who allege their son was neglected at the 24-hour skilled nursing facility he was admitted to.

  • August 14, 2025

    Fired Nurse Accused Of Stealing Drugs Can't Revive Bias Suit

    The Seventh Circuit declined Thursday to reinstate a fired Salvadoran nurse's suit claiming she was accused of stealing and using opioids at work out of bias for her nationality, stating she failed to put forward evidence that her national origin drove concerns rather than her sluggish behavior.

  • August 14, 2025

    20 States Win Injunction Against ICE's Use Of Medicaid Data

    A California federal judge has blocked the federal government from using Medicaid information from 20 states for immigration enforcement purposes, marking a partial victory for the coalition of states challenging a new data-sharing arrangement between the U.S. Department of Health and Human Services and the Department of Homeland Security.   

  • August 14, 2025

    Conn. Lab To Pay $1.25M In False Claims Settlement

    A Connecticut reference laboratory and its operators have struck a deal with federal and state authorities to settle False Claims Act allegations for more than $1.25 million after they allegedly sought payments for medically unnecessary drug tests, federal prosecutors said.

Expert Analysis

  • What 2024 Election Means For Drugs, Medicare And Medicaid

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    With Republicans running the White House, U.S. House of Representatives and U.S. Senate, the incoming administration is likely to provide pathways — through new initiatives and others returning from Trump's previous presidency — for a range of potential changes to drug pricing, Medicare and Medicaid, say attorneys at Morgan Lewis.

  • Justices Mull Sex-Based Classification In Trans Law Case

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    After the U.S. Supreme Court heard oral argument in U.S. v. Skrmetti this week, it appears that the fate of the Tennessee law at the center of the case — a law banning gender-affirming healthcare for transgender adolescents — will hinge on whether the majority read the statute as imposing a sex-based classification, says Alexandra Crandall at Dickinson Wright.

  • Key Takeaways From FDA's Latest Social Media Warnings

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    The U.S. Food and Drug Administration's latest untitled letter concerning a drug company's social media promotion provides lessons for how companies should navigate risk presentation, FDA labeling requirements and superiority claims, say attorneys at Sheppard Mullin.

  • Rank-And-File DOJ Attorneys Will Keep Calm And Carry On

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    Career prosecutors at the U.S. Department of Justice often pride themselves on their ability to remain apolitical in order to ensure consistency and keep the department’s mission afloat, and the incoming Trump administration is unlikely to upend this tradition, says Michael Landman at Bird Marella.

  • Unpacking Arguments From High Court's Rural Hospital Case

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    During oral arguments in Advocate v. Becerra, the U.S. Supreme Court justices focused questions on the meaning of being "entitled to" supplementary security income assistance, and there's reason for optimism that the likely split decision will break in favor of hospitals, say attorneys at King & Spalding.

  • Health Policy Predictions For Trump's Second Administration

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    As President-elect Donald Trump's nominations for health policy and enforcement heads work their way through the confirmation process, healthcare organizations can look at nominee backgrounds, campaign statements and actions from Trump's previous presidency to predict incoming priorities, say attorneys at McDermott.

  • What Trump's Next Term May Mean For Biz Immigration

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    Leonard D'Arrigo at Harris Beach discusses the employment-based immigration policies businesses can potentially expect during President-elect Donald Trump’s second term, based on policies enacted during his first administration, statements made during his campaign and proposals in Project 2025.

  • Weak Reasoning Underlies Fla. Judge's Bold Qui Tam Ruling

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    U.S. District Judge Kathryn Mizelle's groundbreaking decision in U.S. ex rel. Zafirov v. Florida Medical Associates LLC, holding that qui tam provisions of the False Claims Act are unconstitutional, relies on weak logic to reach a conclusion that differs from every other court that has ruled on the issue, says Ethan Greenberg at Anderson Kill.

  • Medicare Overpayment Rules Are A Mixed Bag For Providers

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    The Centers for Medicare & Medicaid Services' updated rules for handling agency overpayments adopt a more reasonable definition of what it means to have "identified" an overpayment, which is a win for providers, but their new time frame for investigating related overpayments is unrealistic, says Susan Banks at Holland & Knight.

  • Expect More State-Level Scrutiny Of Noncompetes Ahead

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    Despite the nationwide injunction against the Federal Trade Commission’s noncompete ban, and the incoming Republican administration, employers should anticipate that state legislatures will continue to focus on laws that limit or ban noncompetes, including those that target certain salary thresholds or industries, says Benjamin Fryer at FordHarrison.

  • Cos. Should Inventory Issues To Prep For New Congress

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    As the legislative and oversight agendas of the 119th Congress come into sharper focus, corporate counsel should assess and plan for areas of potential oversight risk — from tax policy changes to supply chain integrity — even as much uncertainty remains, say attorneys at WilmerHale.

  • Incoming Admin May Shake Up Life Sciences Regulation

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    Though President-elect Donald Trump has not yet articulated policy priorities regarding the life sciences industry, the sector is positioned to see significant changes that could affect everything from drug exclusivity and generic drug approvals, to the availability of over-the-counter drugs, to laboratory-developed tests and digital health, say attorneys at Morgan Lewis.

  • Navigating DOJ's Patchwork Whistleblower Regime

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    In the past few months, the U.S. Department of Justice and several individual U.S. attorney’s offices have issued different pilot programs aimed at incentivizing individuals to blow the whistle on misconduct, but this piecemeal approach may create confusion and suboptimal outcomes, say attorneys at BakerHostetler.