Policy & Compliance

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • October 07, 2025

    4th Circ. Urged To Reverse $10M Medicare Fraud Conviction

    A former physician's assistant on Tuesday requested that the Fourth Circuit reverse a six-year prison sentence for his involvement in a $10 million Medicaid fraud scheme, claiming evidence that could exonerate him was suppressed by a federal district court.

  • October 07, 2025

    DOJ Deal In Medicare Fraud Case A 'Slap On The Wrist'

    Healthcare startup Troy Medicare had big ambitions to revolutionize senior care in the Medicare Advantage market before justice officials learned that thousands of people were being fraudulently enrolled. A former Troy board member calls the company’s nonprosecution agreement a “slap on the wrist.”

  • October 07, 2025

    Drug Tax Outdoes Biblical Punishment, 5th Circ. Judge Says

    A Fifth Circuit panel pressed the U.S. Department of Health and Human Services to justify the basis for the Medicare drug pricing program's steep excise tax, asking Tuesday whether the government had ever levied a higher tax in the nation's history.

  • October 07, 2025

    9th Circ. Rejects 'Kitchen Sink' Challenge To Vaccine Mandate

    A Ninth Circuit panel on Monday upheld a lower court's rejection of a lawsuit brought by dozens of former employees of a nonprofit healthcare system who claimed Washington state's requirement that healthcare workers be vaccinated against COVID-19 violated their statutory and constitutional rights.

  • October 07, 2025

    Northwestern Wants ERISA Health Offering Suit Tossed

    Northwestern University asked an Illinois federal judge on Monday to throw out a proposed class action alleging it breached fiduciary duties in offering a higher-cost health plan alongside a cheaper option, arguing the plaintiffs have failed to allege injury because they admit that they received all the benefits to which they were entitled under the more-expensive plan's terms.

  • October 07, 2025

    Arizona Ruling Delivers Trans Victory Amid Federal Scrutiny

    A recent court order that bars Arizona from requiring proof of surgery before transgender people can change a birth certificate continues a trend of courts making it easier to amend vital records to match a person's gender identity.

Expert Analysis

  • Top 10 Noncompete Developments Of 2024

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    Following an eventful year in noncompete law at both state and federal levels, employers can no longer rely on a court's willingness to blue-pencil overbroad agreements and are proceeding at their own peril if they do not thoughtfully review and carefully enforce such agreements, say attorneys at Faegre Drinker.

  • What 2024 Tells Us About Calif. Health Transaction Reviews

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    Looking back at the California Office of Health Care Affordability's first year accepting notices for material healthcare transactions reveals critical lessons on what the OHCA's review process may mean for the future of covered transactions in the state, say attorneys at Ropes & Gray.

  • Updated HIPAA Rule Is A Necessary Step For Data Protection

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    The U.S. Department of Health and Human Services' updated rules addressing cybersecurity threats in healthcare will necessitate significant investment in technology, training and compliance infrastructure, but are an essential evolution in safeguarding data in an increasingly digital world, say attorneys at Clark Hill.

  • Courts Must Curb The Drug Price Negotiation Program

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    The Inflation Reduction Act's drug price negotiation program upends incentive structures that drive medical innovation, and courts must act appropriately to avoid devastating consequences for American healthcare and the pharmaceutical industry, says Jeff Stier at the Consumer Choice Center.

  • The OIG Report: Preparing For Oversight In 2025

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    Across sectors, Office of Inspector General work plans and challenge reports for 2025 provide a trove of information on the issues and industries that will likely be the focus of government oversight in the year to come, says Diana Shaw at Wiley.

  • 5 Drug And Device Developments That Shaped 2024

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    The last year saw significant legal developments affecting drug and device manufacturers, with landmark decisions and regulatory changes that require vigilance and agility from the industry, say attorneys at Faegre Drinker.

  • How New Fraud Enforcement Tool Affects Gov't Contractors

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    Government contractors will likely face greater scrutiny under the recently enacted Administrative False Claims Act, which broadens federal agencies' authority to pursue low-dollar fraud claims, but contractors may also find the act makes settlement of such claims easier to negotiate, say attorneys at Wiley.

  • Consultants Should Be Aware Of DOJ's Potential New Reach

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    The U.S. Department of Justice's recent first-of-its-kind settlement with McKinsey & Co. indicates not only the DOJ's more aggressive stance toward businesses' potential criminal wrongdoings, but also the benefits of self-disclosure and cooperation when wrongdoing becomes apparent, says Dom Caamano at Kibler Fowler.

  • Health Tech Regulatory Trends To Watch In 2025

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    With an upcoming change in administration and the release of some long-awaited rules, the healthcare industry should prepare for shifting trends, including a growing focus on health data and interest in technology-enabled delivery of healthcare, say attorneys at Orrick.

  • 10 Noteworthy CFPB Developments From 2024

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    In a banner year for consumer finance regulation, the Consumer Financial Protection Bureau made significant strides in its efforts to rein in Big Tech and nonbank financial firms, including via rules regarding open banking, credit card late fees, and buy now, pay later products, say attorneys at Wiley.

  • The Future Of GLP-1 Policy After Drug Shortage Ends

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    If and when the U.S. Food and Drug Administration determines that GLP-1 RA drugs are no longer in short supply, regulators will face questions of how to balance access to GLP-1 RAs with statutory and policy considerations applicable to compounded drugs, say attorneys at Skadden.

  • Top 10 Whistleblowing And Retaliation Events Of 2024

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    From a Florida federal court’s ruling that the False Claims Act’s qui tam provision is unconstitutional to a record-breaking number of whistleblower tips filed with the U.S. Commodity Futures Trading Commission, employers saw significant developments in the federal and state whistleblower landscapes this year, say attorneys at Proskauer.

  • How White Collar Defense Attys Can Use Summary Witnesses

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    Few criminal defense attorneys have successfully utilized summary witnesses in the past, but several recent success stories show that it can be a worthwhile trial tactic to help juries understand the complex decision-making at issue, says Jonathan Porter at Husch Blackwell.