Policy & Compliance

  • September 24, 2026

    Medical School Application Fee Antitrust Claim Moves Ahead

    A D.C. federal court issued an order on Thursday trimming several claims from a class action accusing the Association of American Medical Colleges of inflating medical school application fees, but allowed one of the antitrust claims to move ahead.

  • September 24, 2026

    FDA Nom Says Vaccines Safe, Won't Call IUDs Birth Control

    President Donald Trump's nominee to lead the U.S. Food and Drug Administration faced a Senate committee Thursday morning, where she affirmed the safety of vaccines when pressed but refused to directly contradict the president's false claim that the measles vaccine could be "quite lethal," and declined to affirm that IUDs are birth control and not abortifacients.

  • September 24, 2026

    Autism Therapy Provider Fights $1M MassHealth Demand

    Massachusetts' Medicaid program conducted a flawed audit of autism therapy providers last year and then demanded recoupment of paid claims without a meaningful way to challenge the audit's findings, a national therapy provider said in a lawsuit. 

  • September 24, 2026

    Full 5th Circ. Tough On Aetna's Bid To Arbitrate Aramark Suit

    The Fifth Circuit seemed skeptical Thursday of Aetna's bid to force a health plan benefits dispute from food services giant Aramark into arbitration, with judges picking the insurer's arguments apart during an en banc rehearing.

  • September 24, 2026

    UnitedHealth Blocked From Early Appeal In NM Nurse OT Suit

    A New Mexico federal court has refused to let UnitedHealthcare seek an early appeal of a ruling allowing a nurse case manager's proposed class action to proceed despite an expired statute of limitations, finding the company mischaracterized the ruling and failed to show a genuine circuit split.

  • September 23, 2026

    Blue Shield Still Facing Therapy 'Ghost Network' Suit

    A California federal judge ruled Wednesday that Blue Shield of California must face the majority of claims brought in subscribers' proposed class action alleging the insurer maintained a "ghost network" of mental-health providers that didn't exist or accept new patients, saying the suit adequately claims contract terms were not met.

  • September 23, 2026

    Colo. Judge Declines To Sanction Hospital In Gender Care Suit

    Children's Hospital Colorado properly complied with an injunction prohibiting it from refusing to provide medically necessary gender-affirming care to transgender youth patients, a state judge ruled, rejecting a request by a class of patients to hold the hospital in contempt.

  • September 23, 2026

    Vein Tech Maker Escapes Suit Over DOJ Kickback Probe

    A New York federal judge has tossed, for now, a proposed investor class action alleging that vein disease device maker Inari Medical Inc.'s share price fell after it disclosed an investigation into its compliance with federal anti-kickback laws, finding the suit does not plausibly show Inari was paying healthcare providers unlawful kickbacks, among other things.

  • September 23, 2026

    Healthcare Co. Trims But Can't Escape Retirement Plan Suit

    Nonprofit healthcare system Virtua Health can't avoid a proposed class action alleging its 401(k) plan unlawfully offered a risky and underperforming investment option that provided excessive compensation to plan service providers, a New Jersey federal judge ruled.

  • September 23, 2026

    NYU Langone Inks $5.75M Deal In IT Workers' OT Suit

    NYU Langone agreed to pay $5.75 million to end a proposed class and collective action claiming it misclassified IT support workers, according to a filing in New York federal court.

  • September 23, 2026

    DOJ Pressed On Gender Care Ban In Federal HIV Program

    A Massachusetts federal judge on Wednesday skeptically questioned the Trump administration's authority to prohibit doctors from providing gender-affirming care as part of a longstanding, federally funded HIV program.

  • September 23, 2026

    Health Workers Win OK Of $4M Deal In Time-Rounding Suit

    Workers at an Indiana hospital network secured final approval of a $4 million settlement to resolve their claims that the company systematically shaved time from their pay through a biased rounding system, with a federal judge finding the deal fair and reasonable.

  • September 22, 2026

    Courts Rule On Doc's Prison Term, No Surprises Act And More

    Law360 Healthcare Authority looks at a First Circuit decision backing criminal penalties on a psychiatrist convicted for submitting $19 million in fraudulent claims, the Second Circuit's conclusion that the No Surprises Act doesn't provide a private right of action for enforcing independent dispute resolutions awards, and other appellate rulings affecting the healthcare industry over the last week.

  • September 22, 2026

    FDA Must Revisit MiMedx Wound Care Powder Classification

    A Georgia federal judge vacated the Food and Drug Administration's classification of biomedical company MiMedx's wound care treatment as a biological product, which carries heightened regulatory requirements, finding the agency's determination was arbitrary because it had classified similar products as devices.

  • September 22, 2026

    RI Judge Vacates Feds' Noncitizen Benefit Restrictions

    New York and other states applauded a Rhode Island federal judge's finding that the Trump administration flouted rulemaking requirements when it reinterpreted a 30-year-old welfare reform bill to try to subject a slew of federally funded benefit programs to immigration status verification requirements.

  • September 22, 2026

    Feds Cut 760K Enrollees From ACA Exchanges, Claim Fraud

    The Trump administration on Tuesday said it's kicking about 760,000 enrollees off the Affordable Care Act insurance marketplace, saying they aren't eligible for subsidies or don't exist at all.

  • September 22, 2026

    Dialysis Co., Workers Agree To Resolve 401(k) Forfeiture Suit

    Dialysis company Fresenius has agreed to resolve a proposed class action accusing it of unlawfully using forfeited 401(k) funds to cover its obligations to the plan rather than pay for the plan's administrative fees, according to a Tuesday filing in Massachusetts federal court.

  • September 22, 2026

    HHS Economist Warns Regulation Raises Medicare Spending

    Patient and consumer choice are crucial to driving down healthcare costs, while overregulation tends to increase insurance costs and Medicare spending, the chief economist and regulatory officer of the U.S. Department of Health and Human Services told an economic conference. 

  • September 22, 2026

    8th Circ. Questions Iowa's Bid To Unblock Parts Of PBM Law

    The Eighth Circuit on Tuesday appeared skeptical of the state of Iowa's bid to have the appellate court unblock parts of its law limiting pharmacy benefit managers' power to set drug prices, with multiple judges questioning different aspects of the state's standing and federal preemption analysis.

  • September 21, 2026

    Fla. Judge Keeps Publix Autism Claims Dispute In Fed. Court

    A Florida federal judge has denied a medical services provider's bid to send its lawsuit alleging that Publix Super Markets Inc. underpaid billing claims for children's autism healthcare back to state court, saying their claims are preempted by a federal law regulating employee benefits plans. 

  • September 21, 2026

    Calif. Health Group Accuses SEIU Of 'Shakedown' In RICO Suit

    A group representing California community health clinics has accused a Service Employees International Union affiliate of violating the federal anti-racketeering law, claiming in a new lawsuit that the union places manipulative ballot initiatives before California voters and only withdraws them if the clinics concede to its demands.

  • September 21, 2026

    HHS Can Claw Back $195M In Medicaid Payments From Mich.

    A D.C. federal judge on Monday said Michigan must return almost $200 million in Medicaid payments made to two state-operated psychiatric facilities, agreeing with a finding from the U.S. Department of Health and Human Services' appeals board that the institutions did not meet federal requirements.

  • September 21, 2026

    Ex-NFL Player Gets New Trial In $328M Medicare Fraud Case

    A Texas federal judge has granted a new trial for a former NFL player convicted in a $328 million Medicare billing scheme, finding that the government presented unreliable testimony and did not identify the alleged lies the defendant used to influence physicians.

  • September 21, 2026

    Medical Orgs Target Rule On Medicaid Work 'Frailty' Exclusion

    Federal regulation implementing a statutory "medical frailty" exclusion from Medicaid work requirements violates the Administrative Procedure Act, burdens healthcare providers and threatens to cause millions of people to lose their coverage, medical groups told a Maryland federal court in a complaint.

  • September 21, 2026

    HHS Defends Move To Limit Noncitizen Medicaid Benefits

    The U.S. Department of Health and Human Services has urged a Washington federal court not to block provisions in the 2025 federal budget bill generally denying Medicaid benefits to noncitizens receiving supplemental security income, countering claims of conflicting statutory language.

Expert Analysis

  • Target's ERISA Win Doesn't Ax Tobacco Surcharge Questions

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    Though a Minnesota federal court's recent dismissal of a putative class action challenging Target's tobacco surcharge wellness program offers employers a defense road map, courts' differing conclusions about the Employee Retirement Income Security Act versus U.S. Department of Labor requirements leave the legal landscape unsettled, say attorneys at McGuireWoods.

  • How 'Most Favored Nation' Regime Affects Biopharma Deals

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    As M&A activity surges in the biopharma space, companies will need to account for the Trump administration's most-favored-nation pricing proposals — durable in concept, if unsettled in detail — when drafting deals, say attorneys at Gibson Dunn.

  • Where DOJ's Fraud Priorities Memo May Actually Matter

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    The U.S. Department of Justice’s recently released memo outlining priorities for its newly created fraud division will shape how cases are identified, staffed and sequenced, meaning white collar defense work must begin earlier, say David Tarras at Tarras Defense and Trevor Jones at Dynamis.

  • DOJ Healthcare Declination Offers Self-Disclosure Checklist

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    The U.S. Department of Justice's declination of criminal charges against Campus Eye Management signals that its new self-disclosure policy provides a real path for healthcare companies to avoid criminal exposure, but that path is paved with speed, transparency and operational remediation, says Jonathan Porter at Husch Blackwell.

  • Correctional Healthcare Requires Clearer Legal Standards

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    As the correctional healthcare industry increasingly faces financial instability due to litigation, the U.S. Bureau of Prisons should develop clear standards for constitutionally adequate care for incarcerated patients, says Susanne Moore at Blackstone Trial Group.

  • How Home Infusion Providers Can Adapt To Enrollment Pause

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    Recent Centers for Medicare & Medicaid Services moratoria on new enrollments of home health agencies, medical equipment companies and hospices make home infusion providers' compliance obligations more complex and ambiguous, requiring new careful consideration of specific enrollment requirements and limitations, say attorneys at Quarles & Brady.

  • AI Data Mining Is Changing FCA Enforcement

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    With False Claims Act investigations increasingly emerging from statistical anomalies identified by data miners, companies need to consider what conclusions an outsider armed with artificial intelligence might draw from public-facing data and be ready to explain any anomalies if questions arise, say attorneys at Cohen & Gresser.

  • Lessons From 5 Months Of DOJ Corporate Policy Deals

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    Recent declinations and prosecution agreements between the U.S. Department of Justice and corporations since the March unveiling of the corporate enforcement and voluntary disclosure policy provide takeaways for management considering how to respond to corporate misconduct, says Brendan Quigley at Baker Botts.

  • A New Era Of Scrutiny For China-Linked Pharma Deals

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    As Congress considers bipartisan legislation that would heighten regulatory scrutiny for life sciences deals involving Chinese biotech entities, companies should reassess the risks and due diligence requirements that will come with using heavily China-dependent pipelines, says Jen Maki at Ankura.

  • Justices' FTC Ruling Weakens Qui Tam's Constitutional Base

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    The U.S. Supreme Court’s holding in Trump v. Slaughter, expanding presidential control over those exercising executive power, suggests that courts may be receptive to arguments challenging the constitutional foundations of the False Claims Act’s qui tam mechanism, says Daniel Passeser at Wiggin.

  • Calif. Drug Ruling Affirms Defect-Centric Liability Framework

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    The California Supreme Court's decision in Gilead Tenofovir Cases this week rejects a novel duty-to-innovate theory of negligence that could have reshaped product liability exposure well beyond the pharmaceutical industry, instead signaling that negligence claims premised on nondefective products are unlikely to succeed, say attorneys at Dechert.

  • DOJ's FCA Push Creates Risks For Construction Contractors

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    The construction industry may be uniquely vulnerable to a new generation of False Claims Act enforcement driven by the U.S. Department of Justice's increasing usage of the FCA to target a much broader category of conduct than it has in decades past, specifically compliance certifications and regulatory representations, say attorneys at Cozen O'Connor.

  • Feds' Mixed Cues On Medicaid Fraud Signal States To Step Up

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    While the federal government has recently delivered four distinct and mutually inconsistent messages regarding Medicaid fraud enforcement, states should focus on improving enforcement, regardless of which federal posture proves correct, says Ken Levine at Stone & Magnanini.