Policy & Compliance

Expert Analysis

• Defending Hospital Antisteering Clauses From DOJ Scrutiny

  

  The Trump administration has recently made clear that pursuing antitrust challenges to antisteering provisions in hospital-insurer contracts is a priority — but a review of similar cases against hospital systems and important precedent from the U.S. Supreme Court illuminates some potential defenses in such cases, says Derek Moore at Rule Garza.

• What Expanded CMS Authority Means For Health Compliance

  

  A recent delegation gives the Centers for Medicare & Medicaid Services independent authority to impose permissive exclusions, creating a more active federal enforcement system with heightened risks for healthcare organizations, says Jose Vela at Clark Hill.

• DOJ Directive Gives Contractors A Fraud Risk Road Map

  

  For government contractors, the 10 factors described in the U.S. Department of Justice's recent corporate fraud enforcement directive function as a de facto scoring rubric for internal audits that mirrors what prosecutors will prioritize, say attorneys at Spencer Fane.

• A Nuanced Reading Of DOL's Mental Health Parity Guidance

  

  Though a recent U.S. Department of Labor bulletin may suggest that agency enforcement pressure on group health plans with respect to mental health parity is easing, the takeaways are more complex, and plan sponsors should not relax compliance efforts, say attorneys at Proskauer.

• Where DOJ's Fraud Directive May Actually Affect Enforcement

  

  The U.S. Department of Justice’s recent directive outlining corporate fraud enforcement priorities is mostly a management document instead of a policy, but one part may actually undermine the directive's goals by leading to worse outcomes for organizational defendants and less corporate self-disclosure, says Zachary Warren at Williams & Connolly.

• Importer Risk Rises As AI Enters Trade Fraud Enforcement

  

  The Trump administration's new data-driven and artificial intelligence-enabled push against tariff evasion raises the stakes for companies with global supply chains, making it crucial that they consider strengthening response protocols, documentation and internal reporting mechanisms, say attorneys at Cooley.

• What CMS Audit Rule Means For Medicare Advantage Plans

  

  Despite ongoing legal challenges, the Centers for Medicare & Medicaid Services is moving forward with implementation of its risk adjustment data validation audits, raising statistical concerns around overpayments indicated by variance in unbalanced samples, say Stephen Fink, Brad Rice and Igor Karagodsky at Analysis Group.

• What To Know As State 'Neural Data' Privacy Laws Emerge

  

  Attorneys at Goodwin discuss new state laws aimed at regulating consumer data generated from nervous system activity, explain why neurotechnology is attracting state and federal legislators’ attention, and highlight the compliance obligations that industry players should address now.

• Health Plan Takeaways After 2nd Circ. No Surprises Act Ruling

  

  While the Second Circuit's recent ruling in East Coast Advanced Plastic Surgery v. Cigna gives health plans breathing room in finding that healthcare providers cannot enforce out-of-network billing dispute resolution awards in court, sponsors should not assume that declining to pay awards will go unaddressed by regulators, say attorneys at Thompson Hine.

• Contact Lens Rule's Evolution Steers FTC Guidance Program

  

  The history of the Federal Trade Commission's Contact Lens Rule illustrates the goals of the FTC's recently announced guidance program, which aims to strengthen consumer protection and safeguard competition, say attorneys at Wilson Sonsini.

• Abbott FCA Deal Shows Enforcement Adequacy Quandaries

  

  Abbott Laboratories’ recent False Claims Act resolution illustrates several tricky questions that both prosecutors and defense counsel must address when weighing whether a civil enforcement action alone adequately addresses allegedly wrongful conduct, says James Koukios at MoFo.

• New DNA Screening Standard Has No Clear Playbook

  

  Although the government has not yet released promised guidance intended to support its new standards for screening mail-order DNA, companies should not read this as a reprieve from the Oct. 13 compliance deadline because the delay shifts enforcement risk to statutes that need no new authority, including false statements, the False Claims Act and fraud, says Ashwin Ram at Buchalter.

• Texas Medicaid Fraud Decision Leaves 2 Open Questions

  

  The Texas Supreme Court's decision in Laboratory Corp. of America Holdings v. Texas and NPT Associates, holding that the Texas Medicaid Fraud Prevention Act's omissions provision requires proof of materiality, creates ambiguity about the materiality requirement and about how Texas courts will treat federal precedent going forward, say attorneys at Sidley.