Policy & Compliance
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October 15, 2025
Crowell & Moring Adds Seasoned Healthcare Trial Atty
Crowell & Moring on Wednesday announced that it is expanding its healthcare team with the addition of a first-chair trial attorney who co-founded the healthcare practice at Robins Kaplan LLP, where he was most recently a partner.
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October 15, 2025
Nursing Entities Stiffed Workers On OT, Suit Claims
Two subsidiaries of an operator of nursing facilities automatically deducted unpaid meal breaks that certified nursing assistants were unable to take, leading to unpaid overtime wages, a former employee said in a proposed class and collective action in Colorado federal court.
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October 14, 2025
Providers Bring No Surprises Act Fight To High Court
Two air ambulance providers asked the U.S. Supreme Court to allow them to use the courts to collect on out-of-network billing dispute resolution awards granted under the No Surprises Act, saying that without judicial review, insurers can just skip out on NSA bills to providers.
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October 14, 2025
6th Circ. Won't Revive Allergy Tester's Antitrust Case
The Sixth Circuit refused to revive an allergy testing and treatment company's antitrust case accusing an insurer and a medical group of conspiring to squeeze it out of the market, after finding that doctors are the ones being directly harmed by the alleged activity.
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October 14, 2025
State Fraud Units Step Up To Police Medicaid
The loss of seasoned prosecutors at federal agencies, coupled with the Trump administration’s intense focus on immigration, is undermining the government’s ability to police complex healthcare fraud schemes. State Medicaid fraud units are stepping up.
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October 14, 2025
Meet HHS General Counsel Michael Stuart
Michael Stuart, a former chief federal prosecutor for West Virginia, has been confirmed by the U.S. Senate to serve as general counsel for the Department of Health and Human Services, where he has promised to make healthcare fraud enforcement a priority.
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October 14, 2025
Humana's 2025 Medicare Ratings Sound, Judge Says
A Texas federal judge on Tuesday upheld the Centers for Medicare & Medicaid Services' 2025 star ratings for some of Humana Inc.'s Medicare Advantage plans, saying the agency had the right to hand down a poor rating to the insurer.
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October 14, 2025
Expert Warns Of Autism Claims 'Tsunami' For Vax Program
Drawing on federal data on profound autism, a law professor and former Arnold & Porter partner predicts that a federal declaration that childhood vaccines cause autism could generate roughly $30 billion in new claims a year and bankrupt the National Vaccine Injury Compensation Program.
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October 14, 2025
CMS 'Upcoding' Audit Plan In Doubt After Texas Ruling
The nation's top Medicare official pledged to use a deluge of new audits to beat back "upcoding" overpayments for Medicare Advantage plans. A Texas federal judge blew a hole in the strategy recently by voiding a 2023 rule on data sample extrapolation.
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October 14, 2025
Justices Seek SG Input In 'Lightning Rod' Health Ministry Case
The U.S. Supreme Court Tuesday asked for the U.S. solicitor general to weigh in on a "lightning rod" of a case involving the regulation of nonprofit healthcare-sharing ministries that provide cheap, Christian-friendly health insurance options but aren't legally bound to pay for medical care.
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October 14, 2025
Philly Healthcare Duo Joins Burns White
Burns White LLC announced that a pair of experienced Philadelphia-based attorneys have joined the firm's healthcare practice as a member and of counsel.
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October 14, 2025
Catching Up With Delaware's Chancery Court
Last week at the Delaware Chancery Court, Vice Chancellor Lori W. Will ruled that Carlos Vasallo remains the CEO of Caribevision TV Network LLC, finding that majority investors' attempt to remove him under a defective 2019 agreement was invalid for lack of proper notice.
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October 14, 2025
H-1B Visa Fee Threatens To Deepen Doctor Shortages
A new $100,000 fee for healthcare worker visas is sowing confusion in the medical community and raising concerns that the price tag could block thousands of doctors from practicing in underserved and rural communities.
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October 10, 2025
AstraZeneca Strikes 'Most Favored Nation' Price Deal
Pharmaceutical giant AstraZeneca on Friday cut a deal with the Trump administration to reduce drug prices in the United States, agreeing to provide its medications for Medicaid beneficiaries at discount prices.
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October 10, 2025
Ex-Casino CEO's ERISA Fight Against ND Tribe Gets Trimmed
A North Dakota federal judge trimmed a suit by the ex-CEO of a tribe-owned casino who alleged his healthcare benefits were cut off following a period of leave, finding the court lacked jurisdiction over common law claims, but claims under federal benefits law were sufficiently backed up to reach discovery.
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October 09, 2025
Aetna Inks ERISA Deal Over Nixed Spinal Surgery Claims
Aetna has agreed to pay a class of health plan members up to $55,000 each to resolve their suit alleging their coverage claims for lumbar disk replacement surgeries were wrongfully denied, amounting to a deal worth millions of dollars, according to a California federal court filing.
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October 09, 2025
ADA Doesn't Stop At Prison Gates, 3rd Circ. Says In Reversal
The Third Circuit ordered a lower court to accept an incarcerated man's amended Americans with Disabilities Act lawsuit against a Pennsylvania prison that he says denied him proper medical treatment when a spinal cord injury left him paralyzed in his cell.
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October 09, 2025
San Antonio Abandons Out-Of-State Abortion Travel Appeal
The city of San Antonio on Thursday conceded defeat in its request for court approval to go forward with a program that included funding for out-of-state travel for abortions, handing a victory to the state's attorney general.
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October 08, 2025
Chancery Extends Pause On Hospital Board Law Challenge
The pause on ChristianaCare's lawsuit in Delaware Chancery Court against state officials in which it's challenging legislation that created a state-appointed board to review and approve hospital budgets was extended four months Wednesday to allow more time for the sides to reach a settlement.
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October 08, 2025
$20M Deal Over Wash. Hospital Wage Claims Gets Final OK
A Washington state judge has given the final sign-off on a $20 million deal resolving a class action alleging that the state of Washington, doing business as the University of Washington Medical Center, shortchanged healthcare workers by rounding their hours worked and denying them second meal breaks on longer shifts.
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October 08, 2025
Arnall Golden Sanctioned For Giving Feds ERISA Suit Docs
A California federal judge has ordered Arnall Golden Gregory LLP to pay a $50,000 penalty for giving the U.S. Department of Labor confidential documents United Behavioral Health turned over in a class action accusing the insurer of overcharging workers for out-of-network substance use disorder treatments.
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October 08, 2025
Trump Admin Challenges Denial Of Trans Care Subpoena
The Trump administration told a Massachusetts federal judge that he got it wrong in quashing a subpoena for records of gender-affirming care at Boston Children's Hospital last month, urging the court to reconsider.
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October 07, 2025
Aetna COVID-19 Test Provider Sues Insurer For 'Unpaid' $53M
A Nebraska company that provided COVID-19 testing for Aetna has filed suit in California federal court, alleging that the insurer owes it more than $53 million for testing services but has refused to pay up.
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October 07, 2025
Bausch And Teva Blocked Cheaper IBS Drug, Retailers Say
A slew of retailers on Tuesday accused Bausch Health Cos. Inc. and Teva Pharmaceuticals of working together to keep the generic version of an irritable bowel syndrome drug off the market until 2028, forcing the retailers and other purchasers of the drug to pay monopoly prices.
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October 07, 2025
As Shutdown Continues, Hospital Attys Face Tired Clients
As the government shutdown passes the one-week mark, hospital administrators facing potential financial hits and other heartache from the battle on Capitol Hill are getting tired.
Expert Analysis
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3 High Court Rulings May Shape Health Org. Litigation Tactics
Three separate decisions from the U.S. Supreme Court's most recent term — Loper Bright, Corner Post and Jarkesy — will likely strengthen healthcare organizations' ability to affirmatively sue executive agencies to challenge regulations governing operations and enforcement actions, say attorneys at McDermott.
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A New Way Forward For COVID Vaccine Lawsuit Immunity
As Public Readiness and Emergency Preparedness Act protections for COVID-19 vaccines wane, adding those vaccines to coverage by the National Vaccine Injury Compensation Program would bolster defenses for administrators and manufacturers while also providing stronger remedies for those injured by vaccines, says Altom Maglio at MCT Law.
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Why DOJ's Whistleblower Program May Have Limited Impact
The U.S. Department of Justice’s new whistleblower pilot program aims to incentivize individuals to report corporate misconduct, but the program's effectiveness may be undercut by its differences from other federal agencies’ whistleblower programs and its interplay with other DOJ policies, say attorneys at Milbank.
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How Cos. With Chinese Suppliers Should Prep For Biotech Bill
A proposed bill to prohibit government-affiliated life sciences companies from contracting with Chinese biotech companies of concern may necessitate switching to other sources for research and supplies, meaning they should begin evaluating supply chains now due to the long lead times of drug development, say John O'Loughlin and Christina Carone at Weil Gotshal.
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FTC's Drug Middlemen Probe Highlights Ongoing Scrutiny
The Federal Trade Commission's interim staff report on its inquiry into pharmacy benefit managers suggests that the industry will remain under an enforcement microscope for the foreseeable future due to concerns about how PBMs affect drug costs and accessibility, say attorneys at Arnold & Porter.
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What Cos. Should Note In DOJ's New Whistleblower Pilot
After the U.S. Department of Justice unveiled a new whistleblower pilot program last week — continuing its efforts to incentivize individual reporting of misconduct — companies should review the eligibility criteria, update their compliance programs and consider the risks and benefits of making their own self-disclosures, say attorneys at Skadden.
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Motion To Transfer Venue Considerations For FCA Cases
Several recent decisions highlight the importance for practitioners of analyzing as early as possible whether a False Claims Act case warrants a change of venue, and understanding how courts weigh certain factors for defendants versus whistleblowers, say Ellen London at London & Stout, and Li Yu and Corey Lipton at DiCello Levitt.
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A Primer On EU's Updated Human Substance Regulations
The European Union's updated standards regarding quality and safety of substances of human origin meant for human application carry significant implications for companies that work with cells and tissues, and U.S. companies active in the EU market should pay particular attention to the import and export rules, say Geneviève Michaux and Georgios Symeonidis at King & Spalding.
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CFPB's Medical Debt Proposal May Have Side Effects
The Consumer Financial Protection Bureau’s recent proposal to prevent medical debt information from appearing on consumer reports and creditors from basing lending decisions on such information may have initial benefits for some consumers, but there are potential negative consequences that should also be considered, say attorneys at Cooley.
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15 Areas That Would Change Under Health Data Rule Proposal
If finalized, the Office of the National Coordinator for Health Information Technology's proposed rule will significantly progress its efforts to advance interoperability, respond to stakeholder concerns and clarify compliance with the health IT certification program, say attorneys at Ropes & Gray.
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3 Healthcare FCA Deals Provide Self-Disclosure Takeaways
Several civil False Claims Act settlements of alleged healthcare fraud violations over the past year demonstrate that healthcare providers may benefit substantially from voluntarily disclosing potential misconduct to both the U.S. Department of Justice and the U.S. Department of Health and Human Services, say Brian Albritton and Raquel Ramirez Jefferson at Phelps Dunbar.
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Takeaways From High Court's Tribal Health Admin Cost Ruling
The U.S. Supreme Court's recent determination that the government must reimburse two Native American tribes for administrative healthcare costs will help tribes maintain equal footing with the Indian Health Service when administering programs, and continues a pattern of how the current court aligns on tribal concerns, say attorneys at Lewis Roca.
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FTC Focus: Private Equity Investments In Healthcare
As the Federal Trade Commission is tightening its scrutiny of private equity investment in healthcare, the agency is finding novel grounds to challenge key focus areas, including rollup acquisitions, the flip-and-strip approach and minority investments in rival providers, say attorneys at Proskauer.