Policy & Compliance

  • March 25, 2026

    Insurers, Brokers Can't Exit Medicare Advantage Steering Suit

    A Massachusetts federal judge on Wednesday largely rejected a bid by insurers and brokers to toss claims that they colluded in a kickback scheme to steer Medicare Advantage customers to certain companies and to push away disabled individuals.

  • March 25, 2026

    PBMs Say Mich. Price-Fixing Suit Lacks Specifics

    For the second time, pharmacy benefit managers Express Scripts Inc. and Prime Therapeutics LLC asked a Michigan federal judge on Monday to toss a price-fixing suit filed by Michigan Attorney General Dana Nessel, arguing that the state has no standing to file the suit.

  • March 25, 2026

    Judge Trims SEC Fraud Case Over Cancer Drug Claims

    A Massachusetts federal judge greenlighted U.S. Securities and Exchange Commission claims against two of three former pharmaceutical executives accused of concealing from investors the U.S. Food and Drug Administration's "harsh critiques" about a cancer drug.

  • March 25, 2026

    Foreign Aides' RICO Labor Suit Against PruittHealth Hits NC

    A Tennessee federal judge has agreed to transfer to North Carolina a year-old class action in which foreign workers say a healthcare system and recruiter trapped them in punitive contracts and buried them in grueling labor, after a judge said the action could have been filed in the Tar Heel State in the first place.

  • March 24, 2026

    Nicotine Pouch Maker To Refile FDA Suit In DC After Transfer

    The maker and seller of Zone nicotine pouches on Tuesday dismissed its own lawsuit accusing the U.S. Food and Drug Administration of unfairly holding up a market application for its product, promising to refile in D.C. federal court after a Texas federal court transferred it to South Carolina federal court.

  • March 24, 2026

    Biz Services Co. Faces ERISA Suit Over 'Tobacco Surcharge'

    Business services company Conduent unlawfully imposes health insurance surcharges on employees who use tobacco products, forcing them to pay more for coverage the company provides, a former employee and plan participant said in a proposed class action in New Jersey federal court.

  • March 24, 2026

    $5.7M Cigna Ghost Network Deal Receives Final Go-Ahead

    An Illinois federal judge gave his final sign-off Tuesday to a $5.7 million settlement in what he called an "interesting" case accusing Cigna of improperly advertising out-of-network providers as though they're in-network for certain benefit plans it administered.

  • March 24, 2026

    Health Co. Escapes Workers' 401(k) Forfeiture Suit In La.

    A Louisiana federal judge agreed to toss a federal benefits lawsuit against a health company from workers who alleged the company misspent forfeitures from their employee 401(k) plan, rejecting the workers' argument that funds should have gone toward defraying expenses instead of lowering employer-side contribution obligations.

  • March 24, 2026

    Utah Hospitals To Track Violence As States Step Up Reporting

    Under a new law, Utah hospitals will join a national effort to better understand the risks facing healthcare workers.

  • March 24, 2026

    Ohio Justices Likely Split On Trans Care Restrictions

    The Ohio Supreme Court appeared split Tuesday as to whether a new state law banning gender-affirming care for minors trumps a decade-old healthcare freedom provision passed by voters that says state laws can't block a patient from obtaining healthcare. 

  • March 24, 2026

    Fraud Task Force May Boost White Collar Defense Work

    A new federal anti-fraud task force involving at least a dozen federal agencies could soon expose more state and local governments, contractors, companies and others to compliance risks, particularly in healthcare fraud and False Claims Act cases, experts say.

  • March 24, 2026

    Justices Won't Review Class Cert. In Diabetes Drug Risk Case

    The U.S. Supreme Court has declined to review whether a federal court can certify a class of third-party payors who claim drugmakers hid the cancer risks of an anti-diabetes drug.

  • March 24, 2026

    Mass General Accused Of Shaving Time From Workers' Pay

    Boston-based healthcare system Mass General Brigham shaved as much as 14 minutes a day from employees' pay by rounding their clock-in and clock-out times, according to a proposed class and collective action filed in federal court.

  • March 23, 2026

    J&J Amici Seek Clarity On Goldman Precedent For Class Cert.

    Four groups of amici have urged the U.S. Supreme Court to take up Johnson & Johnson's challenge to a Third Circuit decision allowing a securities class action over its talc products to proceed, warning the ruling could reshape how shareholder suits are litigated nationwide.

  • March 23, 2026

    FTC Stays Focused On Healthcare, Launches Task Force

    The Federal Trade Commission announced it is launching a new task force with staff from across the agency to coordinate healthcare policy approaches and initiate investigations meant to help protect patients, healthcare workers and American taxpayers.

  • March 23, 2026

    Progressive Escapes Workers' Tobacco, Vaccine Fee Suit

    Allegations that Progressive Corp. wrongly charged higher health premiums from workers who used tobacco or refused the COVID-19 vaccination failed to state a claim for violating federal benefits law, an Ohio federal judge ruled as he tossed a proposed class action against the insurance giant.

  • 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.

Expert Analysis

  • New DOJ Penalty Policy Could Spell Trouble For Cos.

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    In light of the U.S. Department of Justice’s recently published guidance making victim relief a core condition of coordinated resolution crediting, companies facing parallel investigations must carefully calibrate their negotiation strategies to minimize the risk of duplicative penalties, say attorneys at Debevoise.

  • A Look At Key 5th Circ. White Collar Rulings So Far This Year

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    In the first half of 2025, the Fifth Circuit has decided numerous cases of particular import to white collar practitioners, which collectively underscore the critical importance of meticulous recordbuilding, procedural compliance and strategic litigation choices at every stage of a case, says Joe Magliolo at Jackson Walker.

  • What US Medicine Onshoring Means For Indian Life Sciences

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    Despite the Trump administration's latest moves to onshore essential medicine manufacturing, India will likely remain an indispensable component of the U.S. drug supply chain, but Indian manufacturers should prepare for stricter compliance checks, says Jashaswi Ghosh at Holon Law Partners.

  • FCA Working Group Reboot Signals EHR Compliance Risk

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    The revival of the False Claims Act working group is an aggressive expansion of enforcement efforts by the Justice Department and the U.S. Department of Health and Human Services targeted toward technology-enabled fraud involving electronic health records and other data, say attorneys at ArentFox Schiff.

  • FDA's Hasty Policymaking Approach Faces APA Challenges

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    Though the U.S. Food and Drug Administration has abandoned its usual notice-and-comment process for implementing new regulatory initiatives, two recent district court decisions make clear that these programs are still susceptible to Administrative Procedure Act challenges, says Rachel Turow at Skadden.

  • The Metamorphosis Of The Major Questions Doctrine

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    The so-called major questions doctrine arose as a counterweight to Chevron deference over the past few decades, but invocations of the doctrine have persisted in the year since Chevron was overturned, suggesting it still has a role to play in reining in agency overreach, say attorneys at Crowell & Moring.

  • A Rapidly Evolving Landscape For Noncompetes In Healthcare

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    A wave of new state laws regulating noncompete agreements in the healthcare sector, varying in scope, approach and enforceability, are shaped by several factors unique to the industry and are likely to distort the market, say attorneys at Seyfarth.

  • Arguing The 8th Amendment For Reduction In FCA Penalties

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    While False Claims Act decisions lack consistency in how high the judgment-to-damages ratio in such cases can be before it becomes unconstitutional, defense counsel should cite the Eighth Amendment's excessive fines clause in pre-trial settlement negotiations, and seek penalty decreases in post-judgment motions and on appeal, says Scott Grubman at Chilivis Grubman.

  • $95M Caremark Verdict Should Put PBMs On Notice

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    A Pennsylvania federal judge’s recent ruling that pharmacy benefits manager CVS Caremark owes the government $95 million for overbilling Medicare Part D-sponsored drugs highlights the effectiveness of the False Claims Act, as scrutiny of PBMs’ outsized role in setting drug prices continues to increase, say attorneys at Duane Morris.

  • DOJ Actions Signal Rising Enforcement Risk For Health Cos.

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    The U.S. Department of Justice's announcement of a new False Claims Act working group, together with the largest healthcare fraud takedown in history, underscore the importance of sophisticated compliance programs that align with the DOJ's data-driven approach, say attorneys at Debevoise.

  • Spotlight On Medicare Marketing Practices Enforcement Trend

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    Recent U.S. Department of Justice actions, including its recent Medicare kickback allegations in Shea v. eHealth, demonstrate increasing enforcement scrutiny on Medicare Advantage marketing practices, say Ellen London at London & Naor, Li Yu at Bernstein Litowitz and Erica Hitchings at the Whistleblower Law Collaborative.

  • Federal Regs Order May Spell Harsher FDCA Enforcement

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    A recent executive order aimed at reducing criminal prosecutions of those who unknowingly violate complex federal regulations may actually lead to more aggressive felony indictments under the Federal Food, Drug and Cosmetic Act, but companies and executives can mitigate risks by following several key principals, say attorneys at McGuireWoods.

  • What High Court's Tenn. Trans Care Ruling Means Nationally

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    The U.S. Supreme Court's decision in U.S. v. Skrmetti, upholding a Tennessee ban on gender-affirming medical care for minors, is fairly limited in scope and closely tailored to the specific language of Tennessee's law, but it may have implications for challenges to similar laws in other states, say attorneys at Hall Render.