Policy & Compliance

  • October 02, 2026

    DOJ Envisions 'Full-Fledged Law Firm' To Combat Gov't Fraud

    The National Fraud Enforcement Division was created less than six months ago, but it is rapidly reshaping the U.S. Department of Justice and spurring an uptick in internal corporate investigations, white collar experts say.

  • October 02, 2026

    6th Circ. Blocks 100s Of Opioid MDL Cases Targeting PBMs

    The Sixth Circuit on Friday overturned a pivotal decision in multidistrict opioid litigation that had dramatically expanded claims against the nation's largest pharmacy benefit managers, saying the MDL's presiding judge "clearly abused" his authority by belatedly allowing hundreds of new cases in one fell swoop.

  • October 02, 2026

    5 Supreme Court Cases To Watch This Fall

    The U.S. Supreme Court will convene Monday to begin its 2026 October term, which includes several cases that could determine the future of climate change tort litigation, expand religious freedoms and parental rights, and grant states authority to require proof of citizenship when individuals register for presidential elections using state forms. 

  • October 02, 2026

    4 Argument Sessions Benefits Attys Should Watch In October

    Former Intel workers' bid to convince the U.S. Supreme Court to revive their suit alleging shoddy retirement plan investments tops the list of oral arguments slated for October that benefits attorneys may want to keep an eye on. Here's a look at that case and three others teed up for argument this month.

  • October 01, 2026

    Home Health Co. Seeks Pause Of Colo. Agency's Backout

    A Colorado home personal care services company exclusively serving those insured by Medicaid urged a state judge Thursday to pause a Colorado regulatory agency's decision to terminate its provider agreement, contending any transition of clients to other providers should come after an administrative court hearing later this month.

  • October 01, 2026

    AbbVie Gets Humira Antitrust Suit Trimmed, But Not Tossed

    An Illinois federal judge tossed all but one claim in a sheet metal worker health plan's putative class action against AbbVie for allegedly causing artificially inflated prices for the rheumatoid arthritis drug Humira, saying the plan sufficiently alleged AbbVie unlawfully stifled competition in the adalimumab market.

  • October 01, 2026

    NH Families Seek To Block Medicaid Ban On Youth Trans Care

    Transgender adolescents and their parents urged a New Hampshire federal court Thursday to block the Trump administration's plan to cut off Medicaid funding for minors' gender-affirming care, arguing it's unconstitutional, motivated by discriminatory animus and violates the Administrative Procedure Act.

  • October 01, 2026

    Judge Bars HHS Medicaid Cuts For Wash. Noncitizens On SSI

    A federal judge has temporarily halted the U.S. Department of Health and Human Services' attempts to cancel Medicaid benefits to noncitizens in Washington state receiving supplemental security income, finding the loss of benefits could lead to permanent disability or death.

  • October 01, 2026

    Fla. Doc Says He Opposed Cruise Co.'s Billing, Got Fired

    A doctor has brought a federal whistleblower lawsuit against Norwegian Cruise Lines Holdings Ltd. in Florida federal court, alleging he lost his job after speaking out against what he believed were fraudulent practices to overcharge passengers for medical services that weren't necessary. 

  • October 01, 2026

    Fla. AG Says Pfizer Hid COVID Vax Risks From Consumers

    Florida's attorney general sued Pfizer and its CEO on Thursday, claiming they deceptively marketed the pharmaceutical company's COVID-19 vaccines as safe despite knowing of reports of adverse events.

  • October 01, 2026

    Calif. Co. Will Pay $20M To Settle COVID Payment Claims

    Los Angeles-based medical lab Signal Diagnostics LLC agreed to pay $20.5 million to settle allegations that it unlawfully retained overpayments for COVID tests for people who had health insurance, according to federal prosecutors.

  • September 30, 2026

    Aetna Escapes Zelis Repricing Tool Antitrust Case

    A Massachusetts federal judge granted Aetna's bid Wednesday to dismiss claims against it in consolidated antitrust litigation accusing insurance companies of using Zelis Healthcare's repricing tools to reduce reimbursements paid to healthcare providers, finding an amended complaint failed to plausibly allege that Aetna used the tools.

  • September 30, 2026

    Ex-NFL Players Object To Proposed Race-Norming Settlement

    More than 100 former NFL players spoke against a proposed class action settlement over allegedly discriminatory cognitive disability assessments, telling a federal judge it threatens to release the league's benefit plans from claims raised in other litigation and deliver largely empty rescoring promises.

  • September 30, 2026

    Pharma Co. Says Mass. Plant Hid FDA Sterility Concerns

    A North Carolina pharmaceutical company says in a complaint filed Wednesday in Massachusetts state court that the company it hired to package a drug for clinical trials involving young children intentionally downplayed a U.S. Food and Drug Administration inspection that flagged multiple contamination issues.

  • September 30, 2026

    Relator Must Seek Part Of $4.7B Opioid Deal In State Courts

    A whistleblower must turn to state courts to pursue his bid for a portion of a $4.7 billion settlement between Walgreens Boots Alliance Inc. and a group of states resolving opioid-related claims against the retail pharmacy chain, an Illinois federal judge ruled.

  • September 30, 2026

    Judge Backs CMS' Contested Organ Procurement Metrics

    Federal health officials didn't violate federal law when they implemented a competitive rule that will alter how organ procurers are rated by decertifying low performers, a Florida federal judge ruled, a holding that could bring wide changes to the organ donor network. 

  • September 30, 2026

    Health Co. Wins Initial Toss Of Retirement Forfeiture Suit

    An Oregon federal judge agreed Wednesday to toss a proposed class action alleging a health company misspent forfeitures from two employee retirement plans by putting assets toward employer-side contribution obligations instead of lowering administrative costs, holding that allegations failed to state a claim for violating federal benefits law.

  • 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.

Expert Analysis

  • AI Data Mining Is Changing FCA Enforcement

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    With False Claims Act investigations increasingly emerging from statistical anomalies identified by data miners, companies need to consider what conclusions an outsider armed with artificial intelligence might draw from public-facing data and be ready to explain any anomalies if questions arise, say attorneys at Cohen & Gresser.

  • Lessons From 5 Months Of DOJ Corporate Policy Deals

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    Recent declinations and prosecution agreements between the U.S. Department of Justice and corporations since the March unveiling of the corporate enforcement and voluntary disclosure policy provide takeaways for management considering how to respond to corporate misconduct, says Brendan Quigley at Baker Botts.

  • A New Era Of Scrutiny For China-Linked Pharma Deals

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    As Congress considers bipartisan legislation that would heighten regulatory scrutiny for life sciences deals involving Chinese biotech entities, companies should reassess the risks and due diligence requirements that will come with using heavily China-dependent pipelines, says Jen Maki at Ankura.

  • Justices' FTC Ruling Weakens Qui Tam's Constitutional Base

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    The U.S. Supreme Court’s holding in Trump v. Slaughter, expanding presidential control over those exercising executive power, suggests that courts may be receptive to arguments challenging the constitutional foundations of the False Claims Act’s qui tam mechanism, says Daniel Passeser at Wiggin.

  • Calif. Drug Ruling Affirms Defect-Centric Liability Framework

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    The California Supreme Court's decision in Gilead Tenofovir Cases this week rejects a novel duty-to-innovate theory of negligence that could have reshaped product liability exposure well beyond the pharmaceutical industry, instead signaling that negligence claims premised on nondefective products are unlikely to succeed, say attorneys at Dechert.

  • DOJ's FCA Push Creates Risks For Construction Contractors

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    The construction industry may be uniquely vulnerable to a new generation of False Claims Act enforcement driven by the U.S. Department of Justice's increasing usage of the FCA to target a much broader category of conduct than it has in decades past, specifically compliance certifications and regulatory representations, say attorneys at Cozen O'Connor.

  • Feds' Mixed Cues On Medicaid Fraud Signal States To Step Up

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    While the federal government has recently delivered four distinct and mutually inconsistent messages regarding Medicaid fraud enforcement, states should focus on improving enforcement, regardless of which federal posture proves correct, says Ken Levine at Stone & Magnanini.

  • A Shift In How Policymakers Are Approaching PBM Regulation

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    Recent federal and state legislative and regulatory activity involving pharmacy benefit managers represent a change in focus from transparency to PBM compensation structures, vertical integration and competitive effects, say attorneys at Barclay Damon.

  • Workplace Menopause Laws Demand New HR Playbooks

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    A recent wave of state and local legislation that makes menopause an expressly protected condition in the workplace creates new compliance obligations amid an already ambiguous federal framework, and demands a workplace culture where employees feel safe asking for support, says Elliot Griffin at Ballard Spahr.

  • States Should Reconsider Forced PBM Divestiture Laws

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    State legislatures are attempting to enact policies intended to force pharmacy benefit managers to divest from pharmacies, but these laws would have the practical effect of reducing patient access and competition, potentially violating the U.S. Constitution in the process, says former Utah Attorney General John Swallow.

  • Noncompete Laws Show States Focusing On Bans, Healthcare

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    The first half of 2026 confirms that state legislatures are driving the most consequential changes in noncompete law, including a few state bans and several healthcare-specific laws, making a one-size-fits-all approach increasingly untenable for multistate employers, say attorneys at Faegre Drinker.

  • Where The Justices Aligned In Appellate Authority Ruling

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    The real story of the U.S. Supreme Court’s recent ruling in T.M. v. University of Maryland Medical System Corp., finding that a doctrine designed to curtail duplicative litigation prevents federal district courts from reviewing state court decisions, is in how the justices together revisited an obscure, century-old jurisdictional doctrine, says Alex Dimitrief at Zeughauser Group.

  • Rare DOJ Military Bias Suit Shows Peril Of Co. Admissions

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    Although the government rarely litigates Uniformed Services Employment and Reemployment Rights Act claims against private employers, Opara v. UV Memory Care demonstrates that it will do so when an employer's own admissions build the case, potentially resulting in significant compliance obligations and long-term consequences, says Bradford Kelley at Littler.