Policy & Compliance

  • June 03, 2025

    Plan Providers Must Face DOJ Overpayment Suit, Judge Says

    A Maine federal judge refused to let five military healthcare plan providers escape a False Claims Act suit alleging that they knowingly pocketed millions of dollars that were overpaid, holding that U.S. Department of Justice claims against them pass muster for now.

  • June 03, 2025

    DC Judge Blocks Trump's Ban On Transgender Prisoner Care

    A D.C. federal judge on Tuesday blocked the enforcement of a Trump administration executive order barring funding of gender-affirming care in federal prisons and granted class certification to a group of transgender inmates challenging the directive.

  • June 03, 2025

    HHS, DOGE Accused Of Using Flawed Data In Mass Layoffs

    Former federal workers laid off by the U.S. Department of Health and Human Services brought a putative class action Tuesday in D.C. federal court alleging their terminations were unlawful because they were based on "hopelessly error-ridden" personnel records, in violation of the Privacy Act.

  • June 03, 2025

    Health Policy Expert On The Changing Vaccine Landscape

    KFF's Jen Kates talks about the changing vaccine landscape, the trickle-down effects of the Trump administration's policies and what she's watching for from federal health officials in the future.

  • June 03, 2025

    2nd Circ. Says Social Worker Can't Challenge NY Abortion Law

    The Second Circuit on Tuesday rejected a social worker's constitutional challenge to a New York law decriminalizing abortion, finding that she lacked standing to sue because she couldn't identify any specific fetus facing harm.

  • June 03, 2025

    Health System, Staffing Co. Accused Of Shaving Work Time

    New York state's largest healthcare provider and a staffing firm unlawfully round down the amount of time employees spend working and deduct 30 minutes from their hours regardless of whether they took a break, according to a lawsuit filed in federal court.

  • June 03, 2025

    The Law360 400: A Look At The Top 100 Firms

    A rebound in client work sent the nation’s largest law firms into growth mode last year, driving a wave of hiring, mergers and strategic moves that reshaped the top tier of the Law360 400. Here's a preview of the 100 firms with the largest U.S. attorney headcounts.

  • June 02, 2025

    9th Circ. Sends Express Scripts Opioid Case To State Court

    The Ninth Circuit sent California's public nuisance lawsuit against Express Scripts and OptumRx over opioid dispensing back to state court Monday and denied the pharmacy benefit managers' bid to stay the remand pending appeal, saying the U.S. Supreme Court's 2009 Nken decision controls, not its later Coinbase ruling.

  • June 02, 2025

    Ore. Psilocybin Access Suit Can Continue, Judge Says

    An Oregon federal judge has ruled that the state's health regulator must face a suit brought under a federal antidiscrimination law that seeks to broaden access for homebound patients to the state's regulated psilocybin program.

  • June 02, 2025

    Nursing Exec Says DOJ Misapplied Justices' Fraud Ruling

    A Nevada nursing home executive convicted of wage-fixing and wire fraud has told a Nevada federal judge that a recent U.S. Supreme Court ruling in a fraud case doesn't preclude his motion for a new trial, contrary to what the U.S. Department of Justice has argued.

  • May 30, 2025

    $5.2M Generic Drug Price-Fixing MDL Deal Gets Final OK

    Apotex Corp. will be paying $5.2 million to settle claims from a class of indirect purchasers alleging the drugmaker was working with other pharmaceutical companies to hike up the price of certain generic medications.

  • May 30, 2025

    5th Circ. To Rehear No Surprises Act Ruling En Banc

    The full Fifth Circuit agreed Friday to reconsider a dispute over provisions for calculating qualifying payments under the 2020 No Surprises Act.

  • May 30, 2025

    DLA Piper Adds Healthcare Regulatory Atty In DC Office

    DLA Piper strengthened its healthcare regulatory resources in Washington, D.C., with the recent addition of an attorney who previously served as acting general counsel for the U.S. Department of Health and Human Services.

  • May 29, 2025

    AstraZeneca Inks $51.4M Settlement In Pay-For-Delay Case

    AstraZeneca Pharmaceuticals LP and Handa Pharmaceuticals LLC have agreed to shell out a combined $51.4 million to put to rest allegations AstraZeneca paid off generic-drug makers, including Handa, to protect its brand antipsychotic drug Seroquel XR, according to a filing Thursday in Delaware federal court.

  • May 29, 2025

    CMS Seeks Hospital Responses On Gender Dysphoria Care

    The Centers for Medicare & Medicaid Services is asking hospitals to produce information on gender dysphoria care provided to children and adolescents, noting in an oversight letter that the U.S. government has "serious concerns" surrounding hormone therapy and other gender-affirming medical interventions.

  • May 29, 2025

    Ga. BCBS Says Providers Are Gaming Billing Dispute System

    Blue Cross Blue Shield of Georgia has accused a healthcare consulting firm and a handful of Peach State providers of systematic abuse of a federal dispute resolution process for surprise medical bills, accusing them of "flooding" the system with bogus dispute claims.

  • May 29, 2025

    Express Scripts Says Arkansas Can't Ban PBM Pharmacies

    Pharmacy benefits manager Express Scripts sued the state of Arkansas in federal court Thursday, alleging that the state's recently enacted law banning PBMs from owning pharmacies in the state violated the U.S. Constitution and ran afoul of federal law governing military employee benefits.

  • May 29, 2025

    Split 9th Circ. Says Spa's Rule On Certain Trans Women Biased

    A divided Ninth Circuit refused to reinstate a Korean spa's constitutional challenge against the Washington State Human Rights Commission and ordered it to rescind its policy denying admission to trans women without gender-affirming surgery, noting Thursday the policy violated state law prohibiting discrimination based on sexual orientation and gender identity.

  • May 28, 2025

    Elon Musk Is Leaving White House Role, Trump Admin Says

    Billionaire Elon Musk is ending his work with President Donald Trump and the federal Department of Government Efficiency, a White House official confirmed Wednesday evening.

  • May 28, 2025

    Justices Told Del. Expert Law Doesn't Apply In Federal Court

    A retired attorney who claims he was negligently injured by healthcare providers urged the U.S. Supreme Court on Tuesday to hold that a Delaware federal court need not apply a state statute requiring an expert affidavit for all medical malpractice suits.

  • May 28, 2025

    Judge Rejects Johns Hopkins Unit's Claim FCA Suit Is Untimely

    A Maine federal judge on Wednesday denied Johns Hopkins Medical Services Corp.'s bid to dismiss a False Claims Act suit as untimely, ruling it must face allegations it failed to report being overpaid for healthcare services for military personnel, retirees and their families.

  • May 28, 2025

    Feds Urge Supreme Court To Let 10th Circ. PBM Ruling Stand

    The federal government urged the U.S. Supreme Court not to take up the state of Oklahoma's challenge to a Tenth Circuit decision that found parts of a law regulating pharmacy benefit managers were preempted by federal benefits and healthcare laws, arguing the case doesn't warrant further review from the justices.

  • May 28, 2025

    Colorado, Feds Clash Over $6.7M From Collapsed Insurer

    A Colorado federal judge pressed the state Wednesday on how its bid to pay out $6.7 million from a defunct health insurer to a Denver Health plan doesn't conflict with the federal government's interests, noting the disbursement would result in less money to a federal risk program.

  • May 28, 2025

    DOJ Says Justices' Ruling Backs Nursing Exec's Conviction

    The U.S. Department of Justice is pointing to a recent U.S. Supreme Court ruling to bolster its fight against a new trial being sought by a convicted Nevada nursing home executive, saying that the new high court decision establishes that economic loss isn't needed to prove wire fraud.

  • May 28, 2025

    Cooley Adds Ex-FDA Attorney To DC Life Sciences Group

    Cooley LLP has hired a former U.S. Food and Drug Administration attorney, who for the majority of her public service career worked as an associate chief counsel, trying civil actions and criminal prosecutions against those accused of violating regulations for a range of products.

Expert Analysis

  • 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.

  • What To Expect Next From Federal Health Tech Regulation

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    Healthcare organizations should pay close attention to federal health information technology regulators' recent guidance concerning barriers to accessing electronic health information, which signals that more enforcement in this area is likely forthcoming, say attorneys at Ropes & Gray.

  • 5 Areas Congress May Investigate After GOP Election Wins

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    With Republicans poised to take control of Congress in addition to the executive branch next year, private companies can expect an unprecedented uptick in congressional investigations focused on five key areas, including cryptocurrency and healthcare, say attorneys at Cahill Gordon.

  • Takeaways From State Votes On Abortion In The 2024 Election

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    Attorneys at Epstein Becker discuss how 10 states voted on ballot initiatives to either protect or restrict access to abortion in the 2024 general election, and analyze overarching trends.

  • Loper Bright Offers New Materiality Defense To FCA Liability

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    The U.S. Supreme Court's decision in Loper Bight Enterprises v. Raimondo, ending Chevron deference, may have created a new defense to False Claims Act liability by providing the opportunity to argue that a given regulation is not material to the government's payment decision, says Tanner Cook at Husch Blackwell.

  • How Expanded Birth Control Coverage May Affect Employers

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    Employers should consider the potential impact of recently proposed regulations that would expand group health plans' required coverage of preventive services and contraceptives, including questions about how the agencies would implement their plans to eliminate the prescription requirement and alter the exceptions process, says Jennifer Rigterink at Proskauer.

  • Legislation Most Likely To Pass In Lame Duck Session

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    As Congress begins its five-week post-election lame duck session, attorneys at Greenberg Traurig break down the legislative priorities and which proposals can be expected to pass.

  • Preserving The FCA Is Crucial In Trump's 2nd Term

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    While the Trump administration may pursue weaker False Claims Act enforcement, it remains an essential tool in safeguarding public funds and maintaining corporate accountability, so now is not the time to undermine ethical behavior, or reduce protections and incentives for whistleblowers, says Adam Pollock at Pollock Cohen.

  • PREVAIL Bill Is Another Misguided Attempt To Restrict PTAB

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    The decade-long campaign against the U.S. Patent and Trademark Office's Patent Trial and Appeal Board — currently focused on the PREVAIL Act that's slated for markup in the Senate — is not really about procedural issues, and it is not aimed at securing more accurate patentability decisions, says Clear IP's Joseph Matal, former acting director at the USPTO.

  • Justices Face Tough Question On HHS Hospital Pay Formula

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    In Advocate Christ Medical Center v. Becerra, the U.S. Supreme Court will determine whether the U.S. Department of Health and Human Services properly applied certain Medicare reimbursement adjustments to hospitals — a decision that could significantly affect hospitals' ability to seek higher Medicare reimbursement for low-income patients, say attorneys at Sheppard Mullin.

  • Key Healthcare Issues That Hinge On The Election Outcome

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    The 2024 presidential race, while not heavily dominated by healthcare issues compared to past elections, holds significant implications for the direction of healthcare policy in a potential Harris or Trump administration, encompassing issues ranging from Medicare to artificial intelligence, says Miranda Franco at Holland & Knight.

  • The Key To Solving High Drug Costs Is Understanding Causes

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    One-sided views on who or what contributes to the high cost of pharmaceuticals render possible solutions much harder to discover and implement, and a better approach would be to examine history and learn why costs have increased and what legislation has and hasn't helped, says Nancy Linck at NJ Linck Consulting.

  • Next Steps For FCA Defendants After Fla. Qui Tam Ruling

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    Because a Florida federal court's recent decision in Zafirov v. Florida Medical Associates could eventually prove to be a watershed event for False Claims Act suits, defendants should consider potential next steps to ensure that their litigation benefits from the court's reasoning and further developments, says Scott Gallisdorfer at Bass Berry.