Policy & Compliance
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October 15, 2025
Judge Won't Block Mich. Medicaid Mental Health Restructure
A Michigan state judge has ruled that the Great Lakes State has the authority to competitively bid and restructure the geographic territory of prepaid inpatient health plans that manage mental health care for the state's Medicaid beneficiaries.
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October 15, 2025
Conn. Hospital Had Cause To Fire Lawmaker, Judge Confirms
A Connecticut judge has confirmed an arbitrator's finding that Norwalk Hospital had "just cause" to fire a now-former state lawmaker, Anabel Figueroa, from her job as a unit coordinator after she made allegedly antisemitic remarks on the campaign trail.
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October 15, 2025
Bankruptcy Can't End Caterpillar Privacy Suit, Ex-Worker Says
A former Caterpillar employee urged an Illinois federal judge on Tuesday not to let his bankruptcy spell doom for his lawsuit claiming the machinery manufacturer illegally collects applicants' family medical histories, arguing he properly used a 'wildcard exemption' to shield his assets from creditors.
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October 15, 2025
Judge Denies Class Cert. In Coast Guard Vax Suit
A U.S. Court of Federal Claims judge declined to certify a proposed class of Coast Guard personnel who were involuntarily removed from active duty after refusing the COVID-19 vaccination, calling their proposed subclasses overly broad and potential claims too unique.
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October 15, 2025
Crowell & Moring Adds Seasoned Healthcare Trial Atty
Crowell & Moring on Wednesday announced that it is expanding its healthcare team with the addition of a first-chair trial attorney who co-founded the healthcare practice at Robins Kaplan LLP, where he was most recently a partner.
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October 15, 2025
Nursing Entities Stiffed Workers On OT, Suit Claims
Two subsidiaries of an operator of nursing facilities automatically deducted unpaid meal breaks that certified nursing assistants were unable to take, leading to unpaid overtime wages, a former employee said in a proposed class and collective action in Colorado federal court.
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October 14, 2025
Providers Bring No Surprises Act Fight To High Court
Two air ambulance providers asked the U.S. Supreme Court to allow them to use the courts to collect on out-of-network billing dispute resolution awards granted under the No Surprises Act, saying that without judicial review, insurers can just skip out on NSA bills to providers.
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October 14, 2025
6th Circ. Won't Revive Allergy Tester's Antitrust Case
The Sixth Circuit refused to revive an allergy testing and treatment company's antitrust case accusing an insurer and a medical group of conspiring to squeeze it out of the market, after finding that doctors are the ones being directly harmed by the alleged activity.
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October 14, 2025
State Fraud Units Step Up To Police Medicaid
The loss of seasoned prosecutors at federal agencies, coupled with the Trump administration’s intense focus on immigration, is undermining the government’s ability to police complex healthcare fraud schemes. State Medicaid fraud units are stepping up.
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October 14, 2025
Meet HHS General Counsel Michael Stuart
Michael Stuart, a former chief federal prosecutor for West Virginia, has been confirmed by the U.S. Senate to serve as general counsel for the Department of Health and Human Services, where he has promised to make healthcare fraud enforcement a priority.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Expert Analysis
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Justices Mull Sex-Based Classification In Trans Law Case
After the U.S. Supreme Court heard oral argument in U.S. v. Skrmetti this week, it appears that the fate of the Tennessee law at the center of the case — a law banning gender-affirming healthcare for transgender adolescents — will hinge on whether the majority read the statute as imposing a sex-based classification, says Alexandra Crandall at Dickinson Wright.
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Key Takeaways From FDA's Latest Social Media Warnings
The U.S. Food and Drug Administration's latest untitled letter concerning a drug company's social media promotion provides lessons for how companies should navigate risk presentation, FDA labeling requirements and superiority claims, say attorneys at Sheppard Mullin.
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Rank-And-File DOJ Attorneys Will Keep Calm And Carry On
Career prosecutors at the U.S. Department of Justice often pride themselves on their ability to remain apolitical in order to ensure consistency and keep the department’s mission afloat, and the incoming Trump administration is unlikely to upend this tradition, says Michael Landman at Bird Marella.
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Unpacking Arguments From High Court's Rural Hospital Case
During oral arguments in Advocate v. Becerra, the U.S. Supreme Court justices focused questions on the meaning of being "entitled to" supplementary security income assistance, and there's reason for optimism that the likely split decision will break in favor of hospitals, say attorneys at King & Spalding.
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Health Policy Predictions For Trump's Second Administration
As President-elect Donald Trump's nominations for health policy and enforcement heads work their way through the confirmation process, healthcare organizations can look at nominee backgrounds, campaign statements and actions from Trump's previous presidency to predict incoming priorities, say attorneys at McDermott.
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What Trump's Next Term May Mean For Biz Immigration
Leonard D'Arrigo at Harris Beach discusses the employment-based immigration policies businesses can potentially expect during President-elect Donald Trump’s second term, based on policies enacted during his first administration, statements made during his campaign and proposals in Project 2025.
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Weak Reasoning Underlies Fla. Judge's Bold Qui Tam Ruling
U.S. District Judge Kathryn Mizelle's groundbreaking decision in U.S. ex rel. Zafirov v. Florida Medical Associates LLC, holding that qui tam provisions of the False Claims Act are unconstitutional, relies on weak logic to reach a conclusion that differs from every other court that has ruled on the issue, says Ethan Greenberg at Anderson Kill.
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Medicare Overpayment Rules Are A Mixed Bag For Providers
The Centers for Medicare & Medicaid Services' updated rules for handling agency overpayments adopt a more reasonable definition of what it means to have "identified" an overpayment, which is a win for providers, but their new time frame for investigating related overpayments is unrealistic, says Susan Banks at Holland & Knight.
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Expect More State-Level Scrutiny Of Noncompetes Ahead
Despite the nationwide injunction against the Federal Trade Commission’s noncompete ban, and the incoming Republican administration, employers should anticipate that state legislatures will continue to focus on laws that limit or ban noncompetes, including those that target certain salary thresholds or industries, says Benjamin Fryer at FordHarrison.
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Cos. Should Inventory Issues To Prep For New Congress
As the legislative and oversight agendas of the 119th Congress come into sharper focus, corporate counsel should assess and plan for areas of potential oversight risk — from tax policy changes to supply chain integrity — even as much uncertainty remains, say attorneys at WilmerHale.
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Incoming Admin May Shake Up Life Sciences Regulation
Though President-elect Donald Trump has not yet articulated policy priorities regarding the life sciences industry, the sector is positioned to see significant changes that could affect everything from drug exclusivity and generic drug approvals, to the availability of over-the-counter drugs, to laboratory-developed tests and digital health, say attorneys at Morgan Lewis.
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Navigating DOJ's Patchwork Whistleblower Regime
In the past few months, the U.S. Department of Justice and several individual U.S. attorney’s offices have issued different pilot programs aimed at incentivizing individuals to blow the whistle on misconduct, but this piecemeal approach may create confusion and suboptimal outcomes, say attorneys at BakerHostetler.
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What To Expect Next From Federal Health Tech Regulation
Healthcare organizations should pay close attention to federal health information technology regulators' recent guidance concerning barriers to accessing electronic health information, which signals that more enforcement in this area is likely forthcoming, say attorneys at Ropes & Gray.