Policy & Compliance

  • March 03, 2026

    Judge Won't Rely On DOJ 'Decency' In Trans Records Case

    A Pennsylvania federal judge blocked the U.S. Department of Justice from getting patient-specific records of gender-affirming care at the University of Pittsburgh Medical Center Children's Hospital, excoriating the government's request and its reasoning for demanding the data.

  • March 03, 2026

    1st Circ. Won't Revive Boston's Opioid Claims Against PBMs

    Boston lost its bid to revive opioid crisis-related claims against two pharmacy benefit managers, as a First Circuit panel affirmed that the suit came years too late.

  • March 03, 2026

    Fla. Billing Co. To Settle With Feds Over $15M Medicare Fraud

    The U.S. government has settled its False Claims Act lawsuit with a medical coding and billing business it accused of aiding a Miami-based laboratory in fraudulently billing Medicare for more than $15 million in genetic tests.

  • March 02, 2026

    High Court Blocks California's Gender Privacy Rule

    The U.S. Supreme Court on Monday reinstated a lower court order that barred California public schools from allowing transgender and gender-nonconforming students to use different names and pronouns at school without their parents' knowledge or consent while the order is appealed.

  • March 02, 2026

    Texas AG Says Gender Care Ban Includes Mental Health

    Mental-health professionals in Texas risk losing their licenses and public funding if they "facilitate" the gender-affirming care banned under state law, said an opinion issued Friday by Attorney General Ken Paxton, which calls them the "gatekeepers."

  • March 02, 2026

    Anthem Avoids Patients' Ghost Network Suit In NY

    A New York federal judge on Monday granted Anthem escape from a proposed class action from patients who alleged inaccuracies in the insurer's mental health provider directory violated New York state laws, holding their claims were preempted by federal employee health benefits law.

  • March 02, 2026

    J&J Unit Wins Bid To Revive Talc Libel Suit With New Basis

    A New Jersey federal judge has revived a bankrupt Johnson & Johnson talc subsidiary's trade libel claim over a 2020 scientific article linking asbestos in talc to mesothelioma, finding that new evidence and allegations concerning the authenticity of the author's data are enough to survive a motion to dismiss.

  • March 02, 2026

    Drugmakers Warn Justices Oregon Pricing Law Risks Secrets

    Pharmaceutical manufacturers have asked the U.S. Supreme Court to overturn Oregon's drug‑pricing transparency law, arguing it forces companies to publicly justify their pricing decisions and give up valuable trade secrets in violation of the First Amendment and the Constitution's takings clause.

  • February 27, 2026

    Recovery Provider Asks For Halt To Anthem's Claims Practices

    A Colorado mental health and substance use treatment facilities operator and its patients asked a Colorado federal judge to stop Anthem Blue Cross and Blue Shield's claims practices, alleging its process violates federal benefits and mental health parity laws and disrupts access to lifesaving care.

  • February 27, 2026

    3rd Circ. Preview: Janssen, Penn State Prof. Seek Relief

    A packed March argument calendar will put several high‑stakes disputes before the Third Circuit, including a billion‑dollar False Claims Act judgment and challenges at the intersection of academic freedom, DEI programming, cannabis‑sector finance and campus Title IX procedures.

  • February 27, 2026

    Credit Bureaus Fight Bid To Add Plaintiffs, Claims To Suit

    Medical providers and a collection agency in a proposed class action accusing Equifax, Experian and TransUnion of conspiring to exclude less than $500 in medical debt from consumer credit reports lack good cause to again amend their complaint, the credit reporting agencies told a federal court. 

  • February 27, 2026

    Judge Says RFK Jr.-Tied Group Can't Join Childhood Vax Suit

    A Massachusetts judge said an anti-vaccine advocacy group with ties to U.S. Department of Health and Human Services Secretary Robert F. Kennedy Jr. cannot join a lawsuit over the federal government's new childhood vaccine schedule, a day after the government said it opposed the group intervening in the case.

  • February 27, 2026

    Minn. State Sens. Introduce Medical Psilocybin Bill

    A pair of Minnesota state senators have introduced a bill to create and regulate a medical psilocybin use program, which would allow residents over 21 with qualifying medical conditions to cultivate and use the drug to treat their conditions.

  • February 27, 2026

    121-Year-Old Ruling Still A Shot In The Arm For Vax Mandates

    Having already withstood five global pandemics, 21 presidencies and more than a century of developments in both the law and public health policy, the U.S. Supreme Court's most durable precedent blessing mandatory vaccination is well positioned to survive a new wave of challenges, experts say.

  • February 27, 2026

    NYC Health Center Sues HHS Over $31M Medicare Repayment

    The U.S. Department of Health and Human Services is unlawfully attempting to recoup more than $31 million in Medicare overpayments made during the COVID-19 pandemic, a New York City skilled nursing center told a federal court, saying it shouldn't have to repay the money.

  • February 27, 2026

    Meta Must Face Worker's Transgender Health Coverage Suit

    Meta can't escape a transgender employee's lawsuit claiming the company's health plan unlawfully denied her coverage of gender-affirming surgeries, an Oregon federal judge ruled, rejecting the company's assertion that she hadn't adequately alleged the plan covered her desired procedures.

  • February 27, 2026

    DOL Extends Comment Window On PBM Transparency Rule

    The U.S. Department of Labor said Friday that the public will be given more time to comment on a new proposed rule that would require pharmacy benefit managers to disclose how much money they've received while serving as intermediaries between drugmakers, pharmacies and insurers.

  • February 26, 2026

    Health Plans Lack Expert In Avandia MDL, 3rd Circ. Told

    Counsel for GlaxoSmithKline urged a Third Circuit panel on Thursday to undo an order certifying a class of health plans in the multidistrict litigation over the company's alleged deceptive marketing of the diabetes drug Avandia, arguing the plaintiffs didn't have the experts necessary to support their case.

  • February 26, 2026

    $95M Kaiser Row Tees Up Challenge For Fund Returns

    Kaiser Foundation Health Plan’s lawsuit seeking $95 million in coverage for a recently settled whistleblower action raises an important challenge to policy language that limits coverage for claims related to returning funds received from government agencies, as policyholder attorneys call for a broad interpretation of the policy language.

  • February 26, 2026

    Feds Back Pharma In 340B Contract Pharmacy Disputes

    State laws that block drugmakers from imposing restrictions on federally funded hospitals and the contract pharmacies they use to dispense discounted drugs under the 340B drug discount program are violating federal law, the Trump administration said, siding with manufacturers in their bid to strike down these laws.

  • February 25, 2026

    Online Abortion Pill Provider Illegally Ships To Texas, AG Says

    Texas Attorney General Ken Paxton sued Aid Access, its founder and a California doctor in state court Tuesday alleging they operate an "abortion-by-mail enterprise" that ship abortion-inducing drugs to Texas residents, which is endangering the lives of unborn children and their mothers. 

  • February 25, 2026

    White House Cites Fraud, Freezes $259M In Minn. Medicaid

    The Trump administration on Wednesday said it would hold back $259.9 million in Medicaid funding for Minnesota as part of what it called an unprecedented effort to combat fraud in programs that support low-income families.

  • February 25, 2026

    Fla. Court Blocks Doctor Dispensing Rules For Worker Claims

    A Florida panel on Wednesday set aside a state agency's proposed rules that would include doctors in a workers' compensation law that gives patients an "absolute choice" over which pharmacist can fill their prescriptions, saying the proposals go beyond what lawmakers intended.

  • February 25, 2026

    Centene Says Filed Rate Doctrine Dooms RICO, Fraud Claims

    Centene Corp. urged an Illinois federal judge Tuesday to grant it partial judgment in a proposed class action by patients alleging the company violated racketeering laws and cheated them out of billions with bogus policies, arguing the filed rate doctrine bars the refunds they seek for alleged overcharges.

  • February 25, 2026

    Pakistan Native Pleads Not Guilty To $10M Healthcare Fraud

    A native of Pakistan who is living in Texas pled not guilty Wednesday to a Chicago indictment claiming he participated in an alleged $10 million healthcare fraud and money laundering scheme involving fake medical companies that filed claims for items and services they never provided.

Expert Analysis

  • The IRS Shouldn't Go To War Over Harvard's Tax Exemption

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    If the Internal Revenue Service revokes Harvard's tax-exempt status for violating established public policy — a position unsupported by currently available information — the precedent set by surviving the inevitable court challenge could undercut the autonomy and distinctiveness of the charitable sector, says Johnny Rex Buckles at Houston Law Center.

  • New Hospice Regulations Should Enforce Core Principles

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    As the U.S. Department of Health and Human Services' Office of Inspector General prepares to research and expand on oversight of Medicare hospice care, the OIG should keep in mind certain core principles, such as an emphasis on preventing the entry of hospices that raise red flags, says Bill Dombi at Arnall Golden.

  • 7 Considerations For Conducting Drug Clinical Trials Abroad

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    With continuing cuts to U.S. Food and Drug Administration staffing motivating some pharmaceutical companies to consider developing drugs abroad, it's important to understand the additional risks and compliance requirements associated with conducting clinical studies in other countries, say attorneys at Morgan Lewis.

  • Compliance Lessons From Warby Parker's HIPAA Fine

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    The U.S. Department of Health and Human Services' civil money penalty against Warby Parker highlights the emerging challenges that consumer-facing brands encounter when expanding into healthcare-adjacent sectors, with Health Insurance Portability and Accountability Act compliance being a potential focus of regulatory attention, say attorneys at Saul Ewing.

  • 5th Circ. Ruling Is Latest Signal Of Shaky Qui Tam Landscape

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    In his recent concurring opinion in U.S. v. Peripheral Vascular Associates, a Fifth Circuit judge joined a growing list of jurists suggesting that the False Claims Act's whistleblower provisions are unconstitutional, underscoring that acceptance of qui tam relators can no longer be taken for granted, say attorneys at Miller & Chevalier.

  • Medicare Advantage Enforcement Strong Amid Agency Cuts

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    The second Trump administration's actions thus far suggest that Medicare Advantage enforcement remains a bipartisan focus despite challenges presented by evolving trends in federal agency staffing and resources, say attorneys at Ropes & Gray.

  • A New Tool For Assessing Kickback Risks In Health Marketing

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    The Seventh Circuit's recent decision in U.S. v. Sorensen, reversing a conviction after trial of a durable medical equipment distributor, highlights two principle considerations for determining whether payments to marketers in healthcare are unlawful under the Anti-Kickback Statute, says Elisha Kobre at Sheppard Mullin.

  • How Trump Orders Affect Health Orgs.' Care For Trans Minors

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    Two recent executive orders issued by President Donald Trump regarding gender-affirming care for minors have put healthcare organizations in a precarious situation, and these institutions should prepare for various implications and potential scenarios, say attorneys at ArentFox.

  • Reproductive Health Under Trump So Far, And What's Next

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    Based on priorities stated so far, the Trump administration will likely continue to weaken Biden-era policies that protect reproductive health, with abortion, in vitro fertilization and contraception all being issues to watch closely amid a post-Dobbs shift, say attorneys at McDermott.

  • What's Next For Lab Test Regulation Without FDA Authority

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    A recent Texas federal court decision vacating the U.S. Food and Drug Administration's final rule that would apply FDA regulations to laboratory-developed tests signals potential positive impacts in the diagnostic space, and could inspire more healthcare entities to litigate against the government, say attorneys at Hooper Lundy.

  • 6 Criteria Can Help Assess Executive Branch Actions

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    With new executive policy changes announced seemingly every day, several questions can help courts, policymakers and businesses determine whether such actions are proper, effective and in keeping with our democratic norms, say Marc Levin and Khalil Cumberbatch at the Council on Criminal Justice.

  • Learning From COVID-19 Enforcement Against Nursing Homes

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    Five years after the COVID-19 outbreak caused a high number of deaths in nursing homes, an examination of enforcement actions against nursing homes in New York and elsewhere in the country highlights obstacles that may arise when bringing cases of this type, and ways to overcome them, says Kenneth Levine at Stone & Magnanini.

  • How Plan Sponsors Can Mitigate Risk In PBM Contracts

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    A recent lawsuit in New York federal court alleges that JPMorgan caused exorbitant prescription costs by mishandling the pharmacy benefit manager arrangement, adding to a growing body of Employee Retirement Income Security Act fiduciary breach litigation and affirming that fiduciaries must proactively manage their healthcare plan vendors, say attorneys at Hall Benefits Law.