Policy & Compliance

  • August 18, 2026

    Aetna Says It Doesn't Use Repricing Tools In Antitrust Case

    Aetna Inc. urged a Massachusetts federal court to toss it from an antitrust case accusing insurance companies of using repricing tools to reduce reimbursements paid to healthcare providers, arguing that a subsidiary, not Aetna, used the tools at issue.

  • August 18, 2026

    NC Doc Gets Prison For Opioid Recovery Prescription Scheme

    A federal judge has sentenced a North Carolina doctor to half a year in prison for letting administrative staff at a nonprofit where he worked as medical director use his credentials to prescribe the opioid use disorder medication buprenorphine to thousands of patients.

  • August 18, 2026

    CMS Aims To Sidestep Past Setbacks In New Trans Care Rule

    A new Medicaid rule that bars federal funding for minors’ gender-affirming care is likely to ignite a swift legal fight over discrimination law, procedural requirements and the reach of last year’s landmark Supreme Court decision in U.S. v. Skrmetti, experts say.

  • August 18, 2026

    Marriott Gets Trim Of Worker's Tobacco Health Fee Suit

    A Maryland federal judge on Tuesday refused to completely toss a Marriott worker's proposed class action alleging the hotel giant's $15 weekly health fee on employees who use tobacco violated federal benefits law, but trimmed the dispute of some claims as insufficiently backed up. 

  • August 18, 2026

    What To Know: AMA Faces Medical Coding Copyright Suit

    A healthcare transparency group is asking a judge for permission to publish the medical codes that help determine the billing for medical procedures, setting up a confrontation with the American Medical Association, which developed the coding system. Here, Law360 takes a closer look at the case and the broader transparency debate.

  • August 17, 2026

    Albertsons Judge Hears $44B Opioid Abatement Plan In Wash.

    Addressing harm caused by prescription opioid abuse in Washington would cost nearly $44.4 billion, an expert testified Monday during a bench trial in the state's case accusing Albertsons and its Safeway subsidiary of exacerbating Washington's overdose crisis by failing to curb the flow of controlled substances.

  • August 17, 2026

    Blue States Say FTC Can't Regulate Trans Youth Health

    A group of left-leaning states, including Massachusetts and California, asked a Texas federal court to toss a Federal Trade Commission suit against the World Professional Association for Transgender Health, saying Monday that the FTC's suit constitutes a "federal attack on state-regulated transgender healthcare."

  • August 17, 2026

    AIG Exclusion Doesn't Bar Multiplied Damages, Judge Says

    A California federal judge in a narrow ruling declared that a portion of Kaiser Foundation Health Plan's insurance policy does not automatically bar coverage for a portion of a $581 million False Claims Act settlement attributable to multiplied damages, but will decide later whether the agreement actually included such damages. 

  • August 17, 2026

    Hospital Employees Seek Class Cert. In Retirement Funds Suit

    Employees of a faith-based nonprofit Colorado hospital urged a federal judge to grant class certification in their lawsuit alleging the hospital mismanaged employees' retirement funds and ultimately cost participants tens of millions of dollars.

  • August 17, 2026

    Mass. Judge Vacates ACA Gender-Affirming Care Restriction

    A Massachusetts federal judge handed a coalition of 21 states a win on their claim that the U.S. Department of Health and Human Services unlawfully issued Affordable Care Act reforms barring marketplace plans from requiring coverage for medical procedures used in gender-affirming care.

  • August 17, 2026

    7th Circ. Reverses Alcoa Union Retirees' Lifetime Benefits Win

    The Seventh Circuit reversed an Indiana federal court's decision holding that certain union retirees of aluminum giant Alcoa and their beneficiaries had a vested right to health benefits for life, finding error with the lower court's judicial estoppel analysis that formed the basis for its judgment on liability.

  • August 14, 2026

    AstraZeneca Joins States Aiming To Block Ill. 340B Drug Law

    AstraZeneca on Friday joined some other large pharmaceutical companies in urging an Illinois federal court to block a new state law that prohibits drugmakers from restricting the types or number of pharmacies healthcare providers can contract with to provide medications under a federal discount drug program.

  • August 14, 2026

    United, Ga. Providers Settle Out-Of-Network Benefits Pay Fight

    United Healthcare has settled claims that three Georgia medical providers that are outside the insurer's network requested "exorbitantly high" reimbursements for care provided to United customers, according to documents filed in Georgia federal court.

  • August 14, 2026

    NC County Sues Bankrupt Hospital Operator For $10M

    North Carolina's Martin County has sued CHS/Community Health Systems Inc. for $10 million in North Carolina federal court, alleging the company failed to honor its obligations to run Martin General Hospital after its affiliate filed for Chapter 7 in 2023.

  • August 14, 2026

    Idaho Abortion Ban Needs Health Exceptions, Judge Finds

    An Idaho federal judge barred the state from criminalizing abortions in cases where continuing a pregnancy puts a patient at risk of lasting harm or death via self-harm, finding that the 14th Amendment establishes a fundamental right to health- and life-preserving abortion care.

  • August 13, 2026

    Albertsons Didn't Flag Suspicious Opioid Orders, Judge Hears

    Albertsons failed to report its pharmacies' unusual opioid orders to the U.S. Drug Enforcement Administration despite explicit instructions from the agency to do so, the retailer's vice president of pharmacy compliance testified Thursday during a bench trial in Washington's lawsuit accusing the chain of exacerbating the state's opioid epidemic.

  • August 13, 2026

    Blue Cross Affiliates Get Trim Of Aramark Health Benefits Row

    A Pennsylvania federal judge on Thursday trimmed but refused to toss a federal benefits lawsuit from food service giant Aramark against a Blue Cross affiliate that administered the company's employee health benefit plans, opening discovery on allegations that improper claims management cost tens of millions and breached fiduciary duties.

  • August 13, 2026

    J&J Says No To Reviving Stelara Case

    Johnson & Johnson has asked the Fourth Circuit not to revive CareFirst's antitrust suit alleging the company tried to monopolize the market for the immunosuppressive drug Stelara.

  • August 13, 2026

    Wash. Halts Conversion Therapy Ban For Therapist Amid Suit

    Washington state has agreed not to enforce its ban on a practice commonly known as conversion therapy against a therapist while his First Amendment challenge to the prohibition plays out in federal court, according to a stipulation entered Thursday.

  • August 13, 2026

    Vaccine Challengers Slam Connecticut's 'One-Party Rule'

    Challengers to Connecticut's mandatory school vaccination laws have accused political leaders of exercising "one-party rule" over state government, claiming the House speaker, governor and attorney general, who are all Democrats, tweaked or defended state laws specifically to stymie their religious freedom claims.

  • August 13, 2026

    Employers Expecting Bump In Health Plan Costs, Survey Says

    GLP-1 medications and catastrophic coverage claims are two leading factors employers anticipate will push health plan costs up 10% in 2027, according to new data released Thursday by the International Foundation of Employee Benefit Plans.

  • August 13, 2026

    Glenmark Will Pay $15.3M To End Humana's Price-Fixing Claims

    The U.S. arm of Glenmark Pharmaceuticals Ltd. has agreed to settle generic-drug price-fixing claims brought by Humana Inc. in three lawsuits centralized in Pennsylvania-based multidistrict litigation, according to a filing with Indian stock exchanges.

  • August 13, 2026

    NC Biz Court Bulletin: Judges Retire, HCA Suit Heads To Trial

    The North Carolina Business Court dropped a host of heavy-hitting opinions in July ahead of two judicial retirements and a new chief judge rising in the ranks.

  • August 12, 2026

    Full 5th Circ. Rejects Planned Parenthood's Immunity Appeal

    The full Fifth Circuit Wednesday tossed an appeal over whether Planned Parenthood is entitled to attorney immunity in a whistleblower suit accusing the organization of improper Medicaid billing, reversing a panel's decision that went in favor of Planned Parenthood.

  • August 12, 2026

    Albertsons Judge Hears Testimony On Rx Opioid, Abuse Link

    An "undeniable" causal link exists between excess prescription opioids and problem use of drugs such as heroin and fentanyl, an expert witness testified during a bench trial Wednesday in Washington's lawsuit accusing Albertsons of fueling the state's overdose crisis by irresponsibly dispensing opioids.

Expert Analysis

  • Informal Announcements Are Reshaping FDA Regulations

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    The U.S. Food and Drug Administration's recent shift toward using press releases, podcasts and other informal channels to announce major policy changes reflects a valid desire to modernize and accelerate regulatory efforts, but it could lead to diminished transparency, increased industry burden and reduced policy durability, says Rachel Turow at Skadden.

  • A Shift In Fed. Circ.'s Approach To Patent Summary Judgment

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    The Federal Circuit's recent decision in Range of Motion v. Armaid may come to be seen as a seminal opinion for potentially exposing and entrenching the Federal Circuit's movement away from its previous framework for identifying obvious noninfringement cases, says Nicholas Nowak at Nowak IP Group.

  • DOJ Actions Suggest Expansion Of Healthcare Enforcement

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    Recent actions by the U.S. Department of Justice and U.S. Food and Drug Administration suggest that federal healthcare enforcement efforts are moving away from traditional program-based fraud and toward cases centered on product integrity, regulatory transparency and telehealth marketing, effectively widening the government's enforcement playbook, say attorneys at MoFo.

  • New Orphan Drug Law Provides A Key Fix For Pharma Cos.

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    The Consolidated Appropriations Act enacted last month restores the U.S. Food and Drug Administration's long-standing interpretation of "same disease or condition," related to orphan drug exclusivity, resolving years of regulatory uncertainty and litigation that have discouraged rare disease research, say attorneys at Spencer Fane.

  • FDA User Fee Talks Offer Clues On Upcoming Reforms

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    As the U.S. Food and Drug Administration undergoes the User Fee Act reauthorization process and renegotiates its user fee agreements over the next several months, the agency's consultation meetings with relevant industries can shed light on the FDA's priorities, and provides stakeholders an opportunity to participate in the reform process, say attorneys at Holland & Knight.

  • Changes Coming To The SBIR And STTR Programs

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    Legislation recently approved by Congress to reauthorize the Small Business Innovation Research and Small Business Technology Transfer Programs includes changes focused on national security that would improve transparency but also increase applicants' administrative burdens, slow the awards process and likely increase litigation, say attorneys at Fluet & Associates.

  • FDA Framework For Personalized Therapies Raises Questions

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    The U.S. Food and Drug Administration's new plausible mechanism framework for developing individualized therapies reflects the agency's focus on rare-disease drugs, but numerous significant, unresolved issues cast uncertainty on how effective the framework will be in practice, say attorneys at Ropes & Gray.

  • Scrutiny Of Nursing Home Practices Marks Inflection Point

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    Recent congressional inquiries into UnitedHealth Group's Medicare Advantage-linked nursing home practices raise questions about whether financial metrics are allowed to influence decisions governed by the standard of care, and could implicate duties imposed by federal regulations, state negligence laws and elder abuse statutes, says Lindsey Gale at Rafferty Domnick.

  • 7 Steps For Gov't Contractors In Post-IEEPA Tariff Landscape

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    In response to U.S. Supreme Court's recent decision to strike down tariffs issued by the Trump administration under the International Emergency Economic Powers Act, there are several actions federal contractors should take to preserve their place in any refund waterfall, and to manage audit, overpayment and False Claims Act risk, say attorneys at Holland & Knight.

  • CMS Healthcare Enforcement Initiatives May Cause Disruption

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    The Centers for Medicare & Medicaid Services' recently announced enforcement actions against healthcare fraud mark a significant escalation, and CMS' prior approach in the hospice sector suggests that even compliant providers and suppliers should brace for impact, say attorneys at Morgan Lewis.

  • What We Know About DOJ's New FCA Enforcement Priorities

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    Recent remarks from the leader of the Justice Department’s commercial litigation branch provide key insights on how False Claims Act cases — especially healthcare fraud, trade fraud, antidiscrimination and cybersecurity claims — will be evaluated, prioritized and pursued as heightened enforcement becomes the new normal, say attorneys at Latham.

  • How PBMs Can Adapt To Plan Sponsors' Disclosure Demands

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    As federal reforms, growing state regulation and litigation threats push plan sponsors to expect visibility into revenue streams, pharmacy benefit managers should leverage transparency strategically, including by simplifying how they get paid, offering clients audit-ready data and co-designing contracts that are easy for fiduciaries to explain and defend, says Kristie Blase at Frazer + Blase.

  • How To Engage With Gov't's Direct-To-Consumer Drug Policy

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    The U.S. Department of Health and Human Services' recent request for industry input on manufacturers' direct-to-consumer drug sales reflects the government's caution in this arena, and allows stakeholders a rare opportunity to help shape policy, says Mary Kohler at Kohler Health Law.