Policy & Compliance

  • May 01, 2026

    Hospitals Say HHS Is Withholding Safety Net Reimbursements

    For more than 20 years, the U.S. Department of Health and Human Services has failed to pay tens of millions in reimbursements to hospitals serving low-income populations by incorrectly factoring service days for patients enrolled in Medicare Part C, a coalition of 91 medical centers claimed in a D.C. federal lawsuit.

  • May 01, 2026

    5th Circ. Pauses Mail-Order Access To Abortion Pills

    The Fifth Circuit on Friday reinstated an in-person dispensing requirement for the abortion medication mifepristone, blocking mail-order access while a challenge to a Biden administration regulation brought by Louisiana officials moves forward.

  • May 01, 2026

    Calif. Sued Over Ballot Measure For Health Clinic Fund Use

    Federally designated community health clinics that serve vulnerable populations sued the California secretary of state and a union to keep an initiative off the November 2026 ballot that would control their budgets and expenditures, warning it could lead to shutdowns, disrupt patients' access to services and have other devastating consequences.

  • May 01, 2026

    DOJ Asks 4th Circ. To Revive Children's Hospital Subpoena

    The U.S. Department of Justice is asking the Fourth Circuit to reverse a district court order quashing its subpoena of transgender minor records from Children's National Hospital in Maryland, arguing that the patients' families — who sued to block the subpoena — lacked standing to bring a HIPAA challenge.

  • May 01, 2026

    Med Groups Say HHS Stalling Challenge To Vax Changes

    A Massachusetts federal judge on Friday rejected the government's request to pause discovery in a challenge by medical groups to the Trump administration's new childhood vaccination schedule while it appeals his March order blocking the changes.

  • May 01, 2026

    Medical Practice's Assets Targeted After $49M Verdict

    The Westchester Medical Group PC has only disclosed $2 million worth of insurance against a $49 million malpractice verdict that could nearly double during an expected appeal, a Connecticut cancer patient and her husband said in seeking to secure the defendant's property and other assets now.

  • May 01, 2026

    Mylan Inks $11M Deal With NC Over EpiPen Pricing

    North Carolina Attorney General Jeff Jackson announced Thursday that the state has inked an $11 million settlement with EpiPen distributor Mylan Pharmaceuticals, resolving claims of anticompetitive conduct and funneling millions back into public healthcare programs.

  • April 30, 2026

    Gov't Pauses Medicaid Data Use For ICE Amid Injunction Fight

    The Trump administration agreed at a hearing Thursday to temporarily halt the use of 22 states' Medicaid data for immigration enforcement purposes until a San Francisco federal judge clarifies the boundaries of an injunction that the largely Democratic-controlled states had accused the government of flouting.

  • April 30, 2026

    Debt Collectors Owe Charity Care Notice, Wash. Justices Say

    Just as hospitals must inform low-income patients they might qualify for financial assistance, so too must agencies collecting on medical debt, the Washington Supreme Court clarified Thursday.

  • April 30, 2026

    Jury Begins Mulling If Doctors Are Liable For Fatal Overdose

    A Philadelphia jury on Thursday began deliberations in a lawsuit accusing two doctors of enabling a 26-year-old man with chronic back pain to become hooked on opioid painkillers and fatally overdose.

  • April 30, 2026

    Trump Taps 3rd Surgeon General Pick, Drops Casey Means

    President Donald Trump nominated his third pick to be surgeon general on Thursday, withdrawing consideration for Casey Means after her confirmation stalled in the Senate. 

  • April 30, 2026

    Supplement Industry Says FDA Wrongly Muzzled Label Claims

    A coalition of dietary supplement companies and an alternative medicine advocacy group filed suit Wednesday against the U.S. Food and Drug Administration, claiming that the agency violated First Amendment commercial speech protections when it blocked product label claims connecting certain nutrients or ingredients to health outcomes.

  • April 30, 2026

    Mental Health Co. Can't Undo Jury Verdict In NC Wage Suit

    A mental healthcare company's bid to throw out a jury verdict finding it willfully violated federal and state wage laws fell short because its post-trial arguments lacked supporting evidence, a North Carolina federal judge ruled Thursday.

  • April 30, 2026

    NC Biz Court Bulletin: Corporate Raid, MV Realty Settlement

    A major case settled in the North Carolina Business Court in April as new lawsuits emerged, including a complaint by health information technology company IQVIA Holdings Inc. accusing its former top brass of orchestrating a corporate raid and defecting to a competitor. In case you missed this story and others, here are the highlights.

  • April 30, 2026

    Express Scripts, Cigna Seek End To Ohio PBM Price Suit

    After the Sixth Circuit ruled that a legal dispute between Ohio and a group of pharmacy benefit managers belongs in federal court, Express Scripts and Cigna now want dismissed the lawsuit accusing them of participating in an antitrust conspiracy that is driving up prescription drug prices. 

  • April 30, 2026

    Kroger's Health Plan Tobacco Fee Shirks ERISA, Suit Says

    Supermarket giant Kroger violated federal benefits law by requiring workers to pay an extra fee through their health plan if they used tobacco while failing to give them a fair opportunity to avoid the charge, according to a proposed class action filed in Ohio federal court.

  • April 30, 2026

    Feds Appeal Order Freezing CDC Childhood Vaccine Changes

    The Trump administration said late Wednesday that it's appealing a court order that stopped its pared-down childhood vaccine schedule from going into effect.

  • April 29, 2026

    CEO Stole From His Company To Buy Mansion, SEC Says

    The former CEO of a California-based pharmaceutical company agreed Wednesday to pay the U.S. Securities and Exchange Commission $30,000 to end a lawsuit accusing him of misappropriating $3.2 million in company funds partly to buy a Beverly Hills mansion.

  • April 29, 2026

    Novo Nordisk Rejects Claim It Influences GLP-1 Market

    Pharmaceutical giant Novo Nordisk told a Texas federal judge that it does not control the GLP-1 market and has not attempted to crush its competition in a bid to dismiss an antitrust suit it is facing.

  • April 29, 2026

    PBMs Say Michigan AG Price-Fixing Suit Is Unsound

    Pharmacy benefit managers Express Scripts, Evernorth Health and Prime Therapeutics have bolstered their effort to escape a federal price-fixing suit brought against them by Michigan's attorney general by arguing the statutes cited in the complaint do not apply to them.

  • April 29, 2026

    Mass. AG, Insurer Settle Deceptive Marketing Claims For $5M

    A Texas-headquartered health insurance agency will pay $5 million to settle allegations that it engaged in deceptive and unfair marketing to sell plans and other types of health programs to thousands of Massachusetts consumers, the state's attorney general announced on Wednesday.

  • April 29, 2026

    5th Circ. Will Rehear Aetna Arbitration Bid In Aramark Suit

    The full Fifth Circuit will reconsider insurance company Aetna's bid to force uniform and food services company Aramark to arbitrate its dispute over employee health benefit claims, staying a panel's ruling from December that had kept proceedings in court.

  • April 29, 2026

    AbbVie Seeks Early Win Over HHS In Botox Drug Price Suit

    When the federal government included Botox in Medicare's drug price negotiation program, which allows Medicare officials to negotiate for lower drug prices, it overstepped its authority, drugmaker AbbVie Inc. told a D.C. federal court, arguing the cosmetic drug and migraine treatment is a "plasma-derived" product ineligible for price controls.

  • April 29, 2026

    Medical Equipment Co. Settles Patient Overbilling Claims

    Patients who claim Pennsylvania-based AdaptHealth Corp. overcharged them for returned medical equipment have reached the final version of a class settlement and will soon submit it to a North Carolina federal court for approval, they told the court this week.

  • April 29, 2026

    Justices Rule NJ Info Demand Chilled Anti-Abortion Speech

    The U.S. Supreme Court on Wednesday unanimously revived an anti‑abortion pregnancy center network's constitutional challenge to a New Jersey subpoena seeking years of donor information, holding that the state's demand infringed free speech.

Expert Analysis

  • 2025 State AI Laws Expand Liability, Raise Insurance Risks

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    As 2025 nears its end, claims professionals should be aware of trends in state legislation addressing artificial intelligence use, as insurance claims based on some of these liability-expanding statutes are a certainty, say attorneys at Wiley.

  • Learning From 2025 FCA Trends Targeting PE In Healthcare

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    False Claims Act enforcement trends and legislative developments from this year signal intensifying state and federal scrutiny of private equity's growing footprint in healthcare, and the urgency of compliance, says Lisa Re at Arnold & Porter.

  • How 11th Circ.'s Qui Tam Review Could Affect FCA Litigation

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    On Dec. 12, the Eleventh Circuit will hear arguments in U.S. ex rel. Zafirov v. Florida Medical Associates, setting the stage for a decision that could drastically reduce enforcement under the False Claims Act, and presenting an opportunity to seek U.S. Supreme Court review of the act's whistleblower provisions, say attorneys at Epstein Becker.

  • How MAHA Is Taking Shape At The State Level

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    The national spotlight on the federal government's Make America Healthy Again movement is bolstering state-level actions regarding potential health impacts of certain food ingredients, increasing the difficulty and importance of maintaining effective compliance programs, say attorneys at Cooley.

  • A Look At Middlemen Fees In 340B Drug Discount Program

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    A U.S. Senate committee's recent hearing on the Section 340B drug discount program, along with statistical analysis of payment amounts, contribute to a growing consensus that middlemen fees are too high, say William Sarraille at the University of Maryland, and Shanyue Zeng and Rory Martin at IQVIA.

  • Nursing Home Abuse Cases Face 3 Barriers That Need Reform

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    Recent headlines reveal persistent gaps in oversight and protection for vulnerable residents in long-term care, but prosecution of these cases is often stymied by numerous challenges that will require a comprehensive overhaul of regulatory, legal and financial structures to address, says Veronica Finkelstein at Wilmington University.

  • Mulling Differing Circuit Rulings On Gender-Affirming Care

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    Despite the Eleventh Circuit's recent holding in Lange v. Houston County that a health plan's exclusion for gender-affirming surgery did not violate Title VII, employers should be mindful of other court decisions suggesting that different legal challenges may still apply to blanket exclusions for such care, say attorneys at Smith Gambrell.

  • State AGs May Extend Their Reach To Nat'l Security Concerns

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    Companies with foreign supply-chain risk exposure need a comprehensive risk-management strategy to address a growing trend in which state attorneys general use broadly written state laws to target conduct that may not violate federal regulations, but arguably constitutes a national security threat, say attorneys at Wiley.

  • Unique Aspects Of Texas' Approach To AI Regulation

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    The Texas Responsible AI Governance Act — which will soon be the sole comprehensive artificial intelligence law in the U.S. — pulls threads from EU and Colorado laws but introduces more targeted rules with fewer obligations on commercial entities, say attorneys at MVA Law.

  • Surveying The Healthcare Policy Landscape Post-Shutdown

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    With last week's agreement to reopen the federal government, at least through the end of January, key healthcare legislation that has been in limbo since a December 2024 spending bill fell apart may recapture the attention of Congress, say attorneys at Faegre Drinker.

  • FDA Biosimilar Guidance Should Ease Biologics Development

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    New draft guidance from the U.S. Food and Drug Administration, indicating that the agency may no longer routinely require comparative efficacy studies when other evidence provides sufficient assurance of biosimilarity, underscores the FDA's trust in analytical technology as a driver of biologics access, say attorneys at Hogan Lovells.

  • Prison Body Cams Raise Health Privacy Compliance Issues

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    The increasing use of prison staff body cameras to enhance transparency and safety presents correctional healthcare partners with new risk management questions where they must carefully reconcile the benefits of surveillance with the imperative to protect patient privacy, say attorneys at Gordon Rees.

  • Employer Considerations After 11th Circ. Gender Care Ruling

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    The Eleventh Circuit's en banc decision in Lange v. Houston County, Georgia, finding that a health plan did not violate Title VII by excluding coverage for gender-affirming care, shows that plans must be increasingly cognizant of federal and state liability as states pass varying mandates, say attorneys at Miller & Chevalier.