Policy & Compliance

  • March 23, 2026

    Feds Approve Minnesota's Plan To Combat Medicaid Fraud

    Minnesota may soon receive the release of $243 million in deferred Medicaid funds after the Centers for Medicare & Medicaid Services approved the state's updated plan to combat Medicaid fraud, Minnesota state health officials told a federal court last week.

  • March 23, 2026

    Health Insurers Can't Force Conn. ERISA Row Into Arbitration

    Elevance Inc. can't compel arbitration of a union health plan's allegations the insurer caused it to pay excessive administrative fees and medical costs, a Connecticut federal judge ruled, finding the insurer and its subsidiaries waived that right by seeking to dismiss the proposed class action.

  • March 23, 2026

    High Court Won't Hear Mich. Newborn Blood Testing Case

    The U.S. Supreme Court on Monday declined to hear a petition from parents seeking to revive claims that the way newborn blood samples are collected and stored in a Michigan health screening program violates their rights to make medical decisions for their children.

  • March 23, 2026

    Justices Won't Review Lab Owner's Kickback Conviction

    The U.S. Supreme Court on Monday declined to review the conviction of a former California biotech president sentenced to eight years in prison for lying about the efficacy of his company's COVID-19 and allergy testing and conducting a $70 million Medicare fraud scheme. 

  • March 23, 2026

    High Court Won't Hear Calif. Border Hospital Medicaid Fight

    The U.S. Supreme Court said Monday it would not consider a case challenging California's exclusions of hospitals in neighboring states from supplemental federal payments going to providers that serve Medi-Cal beneficiaries.

  • March 20, 2026

    Feds Rip Ex-NFL Player's New Trial Bid Over Medicare Scheme

    The federal government opposed a new trial bid by Keith Gray, a former NFL player and Texas laboratory owner convicted in a $328 million scheme involving billing for unnecessary cardiovascular genetic testing for Medicare beneficiaries, arguing Thursday he lacks any valid basis to "disturb the jury's sound verdict."

  • March 20, 2026

    EPA's Ethylene Oxide Plan May Hinder Other Air Toxics Regs

    A new proposal from the U.S. Environmental Protection Agency to weaken emission standards for a medical sterilizer could have broader implications for the agency's power to tighten air pollution limits when new science becomes available.

  • March 20, 2026

    Pa. Hospital Must Pay $109M For Brain Injury During Birth

    Jefferson Health and its subsidiary Einstein Healthcare Network have been hit with a nearly $109 million verdict by a Philadelphia jury in a lawsuit accusing them of negligence leading to debilitating brain injuries sustained by a child delivered at one of their hospitals.

  • March 20, 2026

    Mich. BCBS Unit Gets Health Plans' Claims Fight Transferred

    A federal judge granted Blue Cross Blue Shield of Michigan's request to transfer a proposed class action alleging the insurance company violated federal benefits law by mismanaging claims in self-funded employee healthcare plans it administered, given that a similar, earlier-filed action was proceeding in an adjacent district.

  • March 20, 2026

    Eye On ERISA: A Chat With King & Spalding's Darren Shuler

    Increased scrutiny of health plans and the high costs of care are fueling a litigation uptick that's coming not just from plan participants but also from employers frustrated with their third-party administrators, said Darren Shuler, a partner at King & Spalding LLP. Here, Shuler speaks with Law360 about litigation trends involving the Employee Retirement Income Security Act.

  • March 19, 2026

    HHS Can't Block Trans Care Under Kennedy Edict, Court Says

    A coalition of 21 states and the District of Columbia prevailed on Thursday in their challenge to a Trump administration move to cut access to gender-affirming care for minors when an Oregon federal judge agreed to void a policy statement from Health and Human Services Secretary Robert F. Kennedy Jr.

  • March 19, 2026

    Pharma Group Can't Halt Colo. Law Over Drug Discount Rules

    A Colorado federal judge denied a bid by the Pharmaceutical Research and Manufacturers of America seeking to halt enforcement of a state law guarding providers' ability to contract with pharmacies to distribute discounted drugs under the federal 340B program.

  • March 19, 2026

    Legislative Update: Cannabis And Psychedelics Bill Roundup

    Virginia lawmakers last week gave final approval to legislation that would tax and regulate the sale of adult-use cannabis, Georgia legislators passed a dramatic expansion of the state's medical cannabis program, and Iowa lawmakers approved a bill to designate kratom as a Schedule I substance. Here are the major moves in cannabis and psychedelics legislation from the past week.

  • March 19, 2026

    11th Circ. Partially Reopens Aetna Twin Birth Coverage Fight

    The Eleventh Circuit on Thursday undid Aetna's escape from a worker's coverage dispute over an extended hospital stay for her newborn twins, agreeing with the lower court that allegations failed to state a claim for violating federal benefits law but holding that an amended complaint should have been allowed.

  • March 19, 2026

    Calif. Families Sue Rady Health Over Move To End Trans Care

    Four families have asked a state judge to prevent California's largest pediatric health system from cutting off gender-affirming care for minors, alleging the move would violate state antidiscrimination laws and leave them scrambling to find new providers, some more than 100 miles away.

  • March 19, 2026

    CVS, Caremark Pocket Money Meant For Rebates, Suit Claims

    CVS charges drug manufacturers "exorbitant" fees in exchange for pushing their products, then pockets the money instead of funneling it toward customer rebates as it promises, a federal lawsuit alleges, accusing the company of collecting billions of dollars at customers' expense and violating the anti-racketeering statute.

  • March 18, 2026

    Key Details As 3rd Circ. Ponders FCA's Fate, $1.6B J&J Fine

    Third Circuit judges Wednesday explored divergent views of the False Claims Act's constitutionality and a record fraud verdict against Johnson & Johnson, expressing little eagerness to gut the FCA's whistleblower mechanism, and voicing uncertainty about evidence and jury instructions underpinning the drug promotion punishment.

  • March 18, 2026

    SelectQuote Looks To Escape Investors' Kickback Probe Suit

    SelectQuote has asked a New York federal judge to dismiss a proposed class action accusing it of harming investors by concealing a kickback scheme, which is currently the subject of a suit by the U.S. Department of Justice, arguing the existence of the government's suit is not enough to show the shareholders were damaged.

  • March 18, 2026

    UnitedHealth Customers Denied Class Cert. In PrEP Suit

    Two UnitedHealthcare customers can't turn their Affordable Care Act lawsuit against a company subsidiary into a class action, a Minnesota federal judge ruled Wednesday, denying the pair's bid to represent thousands of customers in litigation accusing the subsidiary of failing to approve full coverage for PrEP.

  • March 18, 2026

    Ed. Dept. Flouting Mental Health Funding Order, States Claim

    The U.S. Department of Education is flouting orders that it fund K-12 mental health grants given to public schools by only partially funding the grants and threatening to withhold remaining funds, a group of state attorneys general told a Washington federal court.

  • March 18, 2026

    Doctor Gets 6½ Years For Healthcare Fraud, Tax Evasion

    An Anchorage, Alaska, physician was sentenced to six and a half years in prison for committing over $16 million in healthcare fraud and tax evasion as part of a scheme that injected sick patients with the wrong medications or dosages, the federal government said Wednesday. 

  • March 18, 2026

    ADA Challenge to Oregon Psilocybin Law Can Proceed

    An Oregon federal judge Tuesday rejected the state's health regulator's bid for a favorable judgment in a suit brought under federal antidiscrimination law, seeking to broaden access for homebound patients to the state's regulated psilocybin program.

  • March 18, 2026

    Health Litigator Rejoins Holland & Knight From In-House Role

    A former Holland & Knight LLP attorney has returned to the firm in Jacksonville, Florida, after a 10-year stint in-house at Florida Blue, a subsidiary of GuideWell Mutual Holding Corp.

  • March 18, 2026

    FDA Can't 'Refuse To File' Tobacco Applications, Suit Says

    The maker and a seller of Zone nicotine pouches are suing the U.S. Food and Drug Administration in Texas federal court, alleging the agency stalled and eventually refused to file their marketing application, despite federal law requiring the FDA to either approve or deny such applications.

  • March 17, 2026

    The Legal Reasoning That Put RFK's Vax Panel On Ice

    The legal reasoning behind a Massachusetts court's decision to freeze major changes to national vaccine policy is simpler than you might expect.

Expert Analysis

  • To Survive FCA Actions, Small Cos. Must Take Offensive Steps

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    A fumbled response to False Claims Act allegations can doom lower-middle-market businesses, and with FCA enforcement hitting record levels for two years, smaller companies must have offensive strategies ready that focus their limited resources on defeating civil qui tam and federal criminal actions, says Derrelle Janey at Olshan Frome.

  • Record FCA Recoveries Signal Intensified Healthcare Focus

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    In its recently released False Claims Act statistics, the U.S. government's emphasis on record healthcare recoveries and government-initiated healthcare matters last year indicates robust enforcement ahead, though the administration's focus on current policy objectives also extends beyond the healthcare sector, say attorneys at Epstein Becker.

  • A Potential Shift In FDA's Approach To Drug Trial Design

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    Recent guidance released by the U.S. Food and Drug Administration clarifying how Bayesian approaches — which combine prior knowledge with new data — may be used in clinical trials reflects the agency's continued interest in innovative trial designs that may accelerate drug approvals, say attorneys at Alston & Bird.

  • What FDA Guidance Means For Future Of Health Software

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    Two significant final guidance documents released by the U.S. Food and Drug Administration last month reflect a targeted effort to ease innovation friction around specific areas, including singular clinical decision support recommendations and sensor-based wearables, while maintaining established regulatory boundaries, say attorneys at Covington.

  • How State FCA Activity May Affect Civil Fraud Enforcement

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    A growing trend of state attorneys general enforcing their False Claims Act analogues independently of the U.S. Department of Justice carries potential repercussions for civil fraud enforcement and qui tam litigation considerations, say Li Yu at Bernstein Litowitz, Ellen London at London & Naor and Gwen Stamper at Vogel Slade.

  • Wage-Based H-1B Rule Amplifies Lottery Risks For Law Firms

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    Under the wage-based H-1B lottery rule taking effect Feb. 27, law firms planning to hire noncitizen law graduates awaiting bar admission should consider their options, as the work performed by such candidates may sit at the intersection of multiple occupational classifications with differing chances of success, says Jun Li at Reid & Wise.

  • Assessing Compliance Risks Around TrumpRx Participation

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    As there are novel compliance obligations and potential political opposition related to the new TrumpRx online drug platform, companies intending to participate on the site should consider the pressure points that are likely to draw enforcement scrutiny, say attorneys at Sheppard.

  • Predicting Actual Impact From CDC's New Vaccine Guidance

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    Recent federal changes to the childhood immunization schedule, reducing the number of vaccine recommendations from 18 to 11, do not automatically create enforceable obligations for parents, schools or healthcare providers, but may spur litigation and other downstream effects on school policies and state guidelines, says Mehdi Sinaki at Michelman & Robinson.

  • What Rescheduling Means For Cannabis Labels, Marketing

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    The proposed reclassification of cannabis is expected to bring heightened scrutiny of labeling, advertising and marketing from the U.S. Food and Drug Administration and the Federal Trade Commission, but the brands that tighten evidence, standardize operations and professionalize marketing controls now will see fewer surprises and better outcomes, say attorneys at Wilson Elser.

  • What's At Stake In Possible Circuit Split On Medicaid Rule

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    A recent Eleventh Circuit decision, reviving Florida's lawsuit against a federal rule that reduces Medicaid funding based on agreements between hospitals, sets up a potential circuit split with the Fifth Circuit, with important ramifications for states looking to private administrators to run provider tax programs, say Liz Goodman, Karuna Seshasai and Rebecca Pitt at FTI Consulting.

  • Courts' Rare Quash Of DOJ Subpoenas Has Lessons For Cos.

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    In a rare move, three federal courts recently quashed or partially quashed expansive U.S. Department of Justice administrative subpoenas issued to providers of gender-affirming care, demonstrating that courts will scrutinize purpose, cabin statutory authority and acknowledge the profound privacy burdens of overbroad government demands for sensitive records, say attorneys at ArentFox Schiff.

  • Remote Patient Monitoring Is At Regulatory Inflection Point

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    With remote patient monitoring at the center of new federal pilot programs and a recent report from the U.S. Department of Health and Human Services' Office of Inspector General examining Medicare billing for those services, it is clear that balancing innovation and risk will be a central challenge ahead for digital health stakeholders, say attorneys at Morgan Lewis.

  • Utah's AI Prescription Renewal Pilot Could Inform Policy

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    Utah recently became the first state to approve an artificial intelligence system for autonomously renewing certain prescription medicines, providing a test case for how regulators may be able to draw boundaries between administrative automation and medical judgment, say Jashaswi Ghosh at Holon Law Partners and Bryant Godfrey at Foley Hoag.