Policy & Compliance

  • July 02, 2026

    CMS Proposes Cut To Hospitals' 340B Drug Reimbursements

    Federal health officials on Thursday proposed a Medicare spending plan that would slash reimbursement for hospitals participating in the 340B drug pricing program and reduce how much all hospitals receive for certain imaging tests.

  • July 01, 2026

    Alibaba Cos. Ink $600M Nonprosecution Deal Over Drug Sales

    Alibaba Group Holding Ltd. and its U.S.-based payment processor AUS Merchant Services Inc. will avoid prosecution and pay $600 million to end the U.S. Department of Justice's allegations that they allowed merchants to sell and import illegal pharmaceuticals and controlled substances into the U.S., the DOJ announced Wednesday.

  • July 01, 2026

    Big Pharma Cos. Want 340B Drug Price FCA Suit Tossed

    Four major pharmaceutical companies Wednesday urged a California federal court to toss False Claims Act allegations revived by the Ninth Circuit claiming they filed false ceiling prices for drugs and overcharged entities covered by a federal discount program, saying the suit is precluded by the FCA's public disclosure bar.

  • July 01, 2026

    Gov't Officials Tout Unprecedented Healthcare Fraud Push

    It's been an unprecedented year for healthcare fraud enforcement, senior government officials from the U.S. Justice Department and Department of Health and Human Services told conference attendees gathered in a ballroom Wednesday morning at the Midtown Hilton in Manhattan.

  • July 01, 2026

    Amgen Wins Order Blocking Colorado's Enbrel Price Cap

    Colorado is preliminarily blocked from enforcing its price cap on Amgen's rheumatoid arthritis drug Enbrel, a federal judge ruled Wednesday, saying the biotech company is likely to succeed on its claim that federal patent law preempts the state's effort to limit the price of patented medications.

  • July 01, 2026

    8th Circ. Keeps Missouri's 340B Contract Pharmacy Law Alive

    The Eighth Circuit declined Wednesday to temporarily block a Missouri law that bars drugmakers from imposing restrictions on federally funded providers that contract with pharmacies to distribute discount drugs in the 340B drug discount program.

  • June 30, 2026

    Health Attys Talk Cooperation In Gov't Fraud Investigations

    For attorneys defending healthcare clients hit with grand jury subpoenas and other enforcement actions investigating potential cases of fraud, cooperation with federal prosecutors is key.

  • June 30, 2026

    AIDS Group Says Cigna-Owned Express Scripts Hurts Patients

    AIDS Healthcare Foundation says its nonprofit wellness centers are going to be run out of business if Cigna-owned pharmacy benefit manager Express Scripts isn't stopped from using its muscle in the market to steer pharmacy patients toward specialty pharmacies it's affiliated with.

  • June 30, 2026

    What To Know As Sen. Cassidy Proposes Changes To 340B

    Newly introduced Senate legislation could radically change the scope of the 340B drug discount program, including by altering how providers tap discounts and provider deals with pharmacies.

  • June 30, 2026

    Remedies, Not Suits: How FTC Approaches Health Mergers

    The Federal Trade Commission has not sued over any healthcare provider mergers since President Donald Trump's return to the White House. Attorneys at the American Health Law Association annual meeting say that's not a signal that the agency is backing off.

  • June 30, 2026

    Judge To Mull Surgeon's Dismissal Bid In 'No Surprises' Suit

    A New Jersey court will soon decide whether allegations that a plastic surgeon abused No Surprises Act arbitration can move forward. Law360 looks at a closely watched case testing what role courts play in this and other NSA disputes.

  • June 30, 2026

    Cigna, Others Fight Ohio AG's Drug Price-Fixing Suit

    Ohio pharmacy benefit managers and their corporate parents urged a federal judge to toss the state's drug price-fixing lawsuit, saying in a series of briefs that the state is trying to skirt federal pleading standards, collapse corporate separateness and stretch Ohio's antitrust law beyond its limits.

  • June 30, 2026

    GEO Still Blocking Parts Of NJ Detention Center, State Says

    New Jersey and its Department of Health told a federal judge that despite consent from U.S. Immigration and Customs Enforcement to tour its Newark detention center, facility operator GEO Group Inc. is still barring entrance to certain areas.

  • June 30, 2026

    Patience Thin On Bench For Dragged-Out FCA Probes

    Judicial frustration was on display in recent rulings in which judges took issue with repeated DOJ requests for sealed records. A desire to speed up fraud cases factors into a fish-or-cut-bait policy for federal prosecutors.

  • June 29, 2026

    Feds Sue Mich., Other States For Not Sharing SNAP Records

    The U.S. Department of Justice is asking federal courts to force Kentucky, Michigan, Minnesota and Pennsylvania to turn over their Supplemental Nutrition Assistance Program applicant data that the Trump administration claims it needs to uncover billions of dollars in overpayments and fraud.

  • June 29, 2026

    26 States Sue To Nix Medicaid Work Rule For Medically Frail

    More than two dozen states sued the Trump administration Monday in Massachusetts federal court in a bid to strike down new Medicaid work requirements for certain enrollees, saying the administration did not consider the consequences the requirements would have on vulnerable Medicaid enrollees.

  • June 29, 2026

    AstraZeneca To Pay $34M In Texas Kickbacks Settlement

    AstraZeneca has agreed to pay nearly $34 million to the state of Texas to put to rest allegations the pharmaceutical company gave kickbacks to providers for prescribing its drugs, many of which were covered by the Lone Star State's Medicaid program, according to an announcement made Monday.

  • June 29, 2026

    Hospital That Halted Gender Care Must Show Cause

    A Colorado state court judge issued a citation on Friday to Children's Hospital Colorado ordering it to show cause for why the hospital refuses to provide gender-affirming care to patients in violation of a preliminary injunction order issued by the Colorado Supreme Court. 

  • June 29, 2026

    Insurers Seek NJ Mass Tort For No Surprises Act Suits

    Five of the largest health insurers in the Garden State have asked the New Jersey Supreme Court 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, according to a notice to the Bar Association.

  • June 29, 2026

    8th Circ. Backs Tossing Ark. Worker's Pharmacy Network Suit

    The Eighth Circuit on Monday turned down an employee health plan participant's bid to revive a proposed class action alleging CVS Caremark unjustly enriched itself by failing to comply with Arkansas laws on pharmacy network adequacy, holding a lower court didn't err in tossing the dispute.

  • June 29, 2026

    Supreme Court To Review Wash. Youth Gender Care Law

    The U.S. Supreme Court will hear a challenge to Washington state's law permitting shelters not to notify the parents of runaway teens who seek gender-affirming treatment, reviving a lawsuit that a Ninth Circuit panel unanimously shot down after a district judge found the plaintiffs could only show speculative injury.

  • June 29, 2026

    Justices Skip New York Health Workers' Fight Over Vax Rule

    The U.S. Supreme Court refused Monday to take up religious healthcare workers' challenge to a pandemic-era New York state policy requiring healthcare providers to make their employees get vaccinated against COVID-19, drawing a dissent from Justices Neil Gorsuch, Clarence Thomas and Samuel Alito.

  • June 26, 2026

    Conn. Provider Must Share Takeover Data After $49M Verdict

    A Connecticut state court has ordered Westchester Medical Group PC to produce corporate takeover documents and leadership information as the court contemplates the provider's bid to set aside a $49 million jury verdict over claims its staff failed to diagnose a woman with cervical cancer.

  • June 26, 2026

    En Banc 4th Circ. Splits Over Stay Of DOD HIV Enlistment Ban

    The Fourth Circuit voted en banc Thursday to grant the federal government's bid to pause a lower court's permanent injunction blocking its policies excluding HIV-positive individuals from enlisting in the military, with a dissenting appellate judge writing that "the government is playing games!"

  • June 26, 2026

    DC Circ. Backs CMS In Medicare Advantage Rating Fight

    A D.C. Circuit panel on Friday upheld the Centers for Medicare & Medicaid Services' calculation of a Louisiana insurer's Medicare Advantage star rating, rejecting the insurer's claims that the agency unlawfully included data from a contract that had been folded into another one.

Expert Analysis

  • Previewing FDA National Priority Vouchers In Psychedelics EO

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    President Donald Trump's recent executive order on psychedelic drug access represents a watershed moment in federal drug policy, but its significance lies in two distinct regulatory pathways, the first being the Commissioner's National Priority Vouchers, which offer a significant opportunity to compress U.S. Food and Drug Administration review, say Kimberly Chew at Husch Blackwell and Odette Hauke at Odette Alina.

  • AG Watch: Texas Charts A Course On Investigative Authority

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    The Texas Supreme Court's recent decision in Texas v. PFLAG affirmed, and arguably expanded, the Texas attorney general's civil investigative demand authority, providing a road map that other courts evaluating state attorney general CIDs may find instructive, amid a lack of precedent, say attorneys at Kelley Drye.

  • Initial Virginia AG Actions Signal Focus On Multistate Efforts

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    Now that Virginia Attorney General Jay Jones has reached the 100-day mark in office, his first set of actions reveals a clear preference for coalition with regional and national counterparts, which means the primary risk for businesses is no longer just the fact of enforcement, but the speed at which investigations can escalate, says Lauren Cooper at Hogan Lovells.

  • How CMS Fraud Priorities Complicate Provider Acquisitions

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    As the Centers for Medicare & Medicaid Services steps up usage of its affiliates authority and post-transaction audits, parties contemplating the acquisition or sale of home health and hospice providers should take steps to avoid the potential suspension of Medicare billing privileges, say attorneys at Alston & Bird.

  • Mapping Philly US Atty's White Collar Enforcement Push

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    Attorneys at Blank Rome discuss the U.S. Attorney for the Eastern District of Pennsylvania David Metcalf’s commitments and priorities, survey early results from his first year, and suggest practical action items for companies operating under the office's jurisdiction.

  • How The Coming Months Will Shape State Drug Price Boards

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    The future of state prescription drug affordability boards may be determined in the next few months, between an upcoming court decision in a challenge against state authority to set drug prices, and pending state decisions about whether to use federal Medicare maximum fair prices as reference, say Michael Kolber, Steven Chen and Kelechi Ezealaji at Manatt.

  • Steps To Consider As DOJ Launches Fraud Division

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    The establishment this month of the National Fraud Enforcement Division within the U.S. Department of Justice is a significant reorganization that suggests an increase in enforcement activity involving federally funded programs but leaves a number of important questions unanswered, say attorneys at Crowell & Moring.

  • Court's HRSA Policy Reversal Leaves 340B Rules Murky

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    A D.C. federal court's recent decision in Premier v. U.S. Department of Health limits the Health Resources and Services Administration's ability to enforce long-standing Section 340B interpretations through subregulatory guidance, leaving open core statutory questions about purchasing models, inventory classification and program oversight, says Martha Cramer at Hooper Lundy.

  • Fresenius Ruling May Shift Anti-Kickback Enforcement

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    The Ninth Circuit's recent decision in Fresenius v. Bonta suggests that businesses have a First Amendment right to donate to certain charities, even if those donations are motivated by economic self-interest, potentially calling into question years of Anti-Kickback Statute proceedings against pharmaceutical manufacturers for making similar donations, says Jonah Knobler at Patterson Belknap.

  • The Challenge Of Stabilizing Rural Hospitals On The Brink

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    The outlook for rural hospitals has grown more concerning, as recent policy and regulatory developments are decreasing hospital revenues and increasing the cost of uncompensated care, which may result in additional hospital closures, service reductions, or mergers and acquisitions, say Omur Celmanbet, Kristy Piccinini and Sabiha Quddus at FTI Consulting.

  • Fraud Enforcement, Sentencing Face Unusual Convergence

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    The Trump administration’s newly created task force to eliminate fraud and the U.S. Sentencing Commission’s recent proposals to scale back certain elements of the federal sentencing framework seem to point in opposite directions, creating a collision of policy priorities that may reshape how fraud cases are charged, negotiated and sentenced for years to come, says David Tarras at Tarras Defense.

  • Peptide Policy Is Shifting Toward Sanctioned Compounding

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    The policy landscape for peptides is undergoing a significant shift under the Trump administration, moving toward a complex system of verified compounding and complementary enforcement that will likely bring peptides firmly back into the sphere of legitimate consumer products, say attorneys at Sheppard.

  • Trump Order Signals Tougher Benefits Fraud Probes

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    A recent order from President Donald Trump establishing a federal taskforce for addressing fraud in federally funded benefit programs emphasizes interagency information sharing, potentially affecting a broad range of areas including government contracts, administrative law considerations and False Claims Act cases, say attorneys at Morgan Lewis.