Policy & Compliance

  • May 19, 2026

    Anthem Inks $3.6M Settlement In Proton Beam Therapy Suit

    Anthem and its affiliates have agreed to fork over approximately $3.6 million to end a proposed class action from employee health plan participants who challenged coverage denials for proton beam therapy to treat cancer, according to Tuesday filings in Tennessee federal court.

  • May 18, 2026

    PBMs Tell Mich. Court They're Not To Blame For Opioid Abuse

    Pharmacy benefit managers told a Michigan federal court on Monday they are not responsible for opioid abuse because they do not control prescription drugs once they are sold to patients, as Evernorth Health, Express Scripts and other companies seek an exit from the state attorney general's public nuisance suit.

  • May 18, 2026

    Aetna Denied A Freeze On Trans Facial Surgery Order

    A Connecticut federal judge ordered Aetna to comply with a preliminary injunction requiring it to reconsider coverage denials affecting two transgender health plan participants who sought gender-affirming facial surgery, refusing to stay the insurer's compliance obligations during its pending appeal in the proposed class action.  

  • May 18, 2026

    Morgan & Morgan Atty Barred From Harvard Suit Over AI Error

    A Massachusetts judge on Monday said a Morgan & Morgan PA attorney may not appear before him in a suit against Harvard University over the theft of body parts donated to its medical school, saying the lawyer did not learn his lesson after signing off on briefs in another case with fake case law generated by artificial intelligence.

  • May 18, 2026

    Justices Deny Eli Lilly's Qui Tam Constitutional Challenge

    The U.S. Supreme Court on Monday declined to review Eli Lilly's $183 million trial loss to a whistleblower who claimed the drugmaker knowingly defrauded the government by underpaying Medicaid drug rebates.

  • May 18, 2026

    Colo. Justices Tell Hospital To Resume Gender-Affirming Care

    The Colorado Supreme Court ordered Children's Hospital Colorado on Monday to resume its provision of gender-affirming care for transgender youth patients, finding the patients demonstrated actual harm from the denial of care.

  • May 18, 2026

    High Court Spurns Pharma Challenges To IRA Drug Price Talks

    The U.S. Supreme Court rejected six petitions Monday from pharmaceutical giants seeking to bring down the Medicare drug price negotiations established as part of the Inflation Reduction Act three years ago.

  • May 15, 2026

    Texas Hospital Creates 'De-Transition Clinic' After Settlement

    The Texas attorney general announced a settlement with Texas Children's Hospital that will see the creation of a detransition clinic, saying Friday that the hospital will pay $10 million for billing Texas Medicaid for "illegal 'gender-transition' interventions."

  • May 15, 2026

    Minn. Twins Doctor Can't Claim Immunity In Player Death Suit

    A doctor employed by the Minnesota Twins can't claim immunity in a lawsuit alleging he failed to diagnose a heart condition in a ballplayer that led to his death, a Florida appeals panel ruled on Friday.

  • May 15, 2026

    4th Circ. Hands Express Scripts Jury Trial In W.Va. Opioid Suit

    The Fourth Circuit on Friday issued a writ of mandamus backing Express Scripts Inc.'s right to a jury trial in litigation over the pharmacy benefit manager's alleged role in contributing to the opioid crisis in West Virginia.

  • May 15, 2026

    Texas Justices Revive Anti-SLAPP Bid In Abortion Fund Suit

    The Texas Supreme Court on Friday revived a woman's anti-SLAPP bid in an abortion fund's suit against her, holding that the suit was filed in response to the woman's earlier attempt to investigate the fund's deputy director for potential violations of state abortion law.

  • May 15, 2026

    NC Social Worker Wants Resentencing In Medicaid Fraud Suit

    A clinical social worker in North Carolina serving more than 11 years in prison on healthcare fraud charges is challenging her sentence in the Fourth Circuit, saying Thursday that a lower court used overly generalized findings to apply a vulnerable victim sentence enhancement.

  • May 14, 2026

    NJ Doctor Prescribed Medical Marijuana To Kids, AG Says

    A New Jersey doctor had his medical license temporarily suspended by a state board, which found there is good reason to believe he is "a grave danger" to his patients after prosecutors accused him of repeatedly prescribing marijuana to adults and children without complying with state law.

  • May 14, 2026

    NC Republicans Want Fetal Personhood Question On '26 Ballot

    Two Republicans in the North Carolina House who have a history of advancing so-called fetal personhood bills have made another attempt to put a constitutional amendment to voters in November to decide if life begins at fertilization.

  • May 14, 2026

    Pa. Psych Hospital Faces Multiple Abuse Lawsuits

    A Pittsburgh-area psychiatric hospital has been hit with five state court lawsuits alleging it allowed patients as young as 10 years old to be physically and sexually abused by staff members and other patients, despite multiple investigations and warnings.

  • May 14, 2026

    Moda Health Settles Wilderness Therapy Coverage Suit

    Health insurance provider Moda Health has agreed to settle a lawsuit alleging it unlawfully denied a family's claims for their daughter's stays at two wilderness therapy programs and left them with thousands of dollars in medical bills, according to a filing in Oregon federal court.

  • May 14, 2026

    Albertsons Not Covered In Opioid Litigation, Del. Judge Says

    Albertsons isn't entitled to defense or indemnity for more than 100 suits accusing the pharmacy and grocery chain of fueling the opioid epidemic, a Delaware state court ruled, tracking the state high court's rulings in nearly identical disputes involving Rite Aid and CVS.

  • May 14, 2026

    High Court Maintains Abortion Pill Access Amid Circuit Appeal

    The U.S. Supreme Court on Thursday extended a stay preserving telehealth access to the abortion medication mifepristone while the Fifth Circuit weighs a challenge to the mail-order distribution of the pill.

  • May 14, 2026

    NC Healthcare Workers Get Final Nod On $1.5M Wage Deal

    A federal judge has given final approval to a $1.56 million settlement with the owners of several North Carolina hospitals and healthcare facilities accused of manipulating workers' time sheets to skirt overtime requirements.

  • May 14, 2026

    Time For Trial, Judge Says, Nixing DQ Appeal In Generics MDL

    A Pennsylvania federal judge has refused to let generic-drug makers seek Third Circuit intervention in their bid to disqualify the lead counsel for insurers Humana and Molina, concluding the fight would only further delay the long-running case ahead of its first trial in the price-fixing multidistrict litigation.

  • May 13, 2026

    CMS To Keep $1.3B From Calif., Halt New Hospice Enrollment

    The federal government on Wednesday announced it will defer more than $1.3 billion in Medicaid funds from California and halt new Medicare enrollments for hospices and home health agencies, saying it was part of an effort to crack down on fraudulent activity.

  • May 13, 2026

    3 NJ Employers Accused Of Pregnancy Discrimination

    A New Jersey hospital system, a laboratory company and a cleaning business must answer to allegations that they engaged in pregnancy discrimination in the workplace, state enforcers said this week.

  • May 13, 2026

    Washington Hits Providence Health With Pregnancy Bias Suit

    Washington slapped Providence Health & Services with a lawsuit Wednesday claiming the health system routinely rejected accommodation requests from pregnant employees, denying them spaces to pump breast milk, seating and schedule flexibility to attend doctor appointments.

  • May 13, 2026

    DOJ Fraud Division Set To Shake Up White-Collar Enforcement

    President Donald Trump's administration created the U.S. Department of Justice's National Fraud Enforcement Division with a narrow focus on combating government program fraud, but a move to retain federal prosecutors focused on other types of fraud could signal a wider scope with potential ripple effects across white-collar enforcement.

  • May 13, 2026

    Becton Hernia Mesh Antitrust Case Survives Dismissal

    A Pennsylvania federal court has refused to toss an antitrust case from Tela Bio Inc. accusing Becton Dickinson & Co. of abusing its dominant position in the hernia mesh market to block competing products.

Expert Analysis

  • The IRS Shouldn't Go To War Over Harvard's Tax Exemption

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    If the Internal Revenue Service revokes Harvard's tax-exempt status for violating established public policy — a position unsupported by currently available information — the precedent set by surviving the inevitable court challenge could undercut the autonomy and distinctiveness of the charitable sector, says Johnny Rex Buckles at Houston Law Center.

  • New Hospice Regulations Should Enforce Core Principles

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    As the U.S. Department of Health and Human Services' Office of Inspector General prepares to research and expand on oversight of Medicare hospice care, the OIG should keep in mind certain core principles, such as an emphasis on preventing the entry of hospices that raise red flags, says Bill Dombi at Arnall Golden.

  • 7 Considerations For Conducting Drug Clinical Trials Abroad

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    With continuing cuts to U.S. Food and Drug Administration staffing motivating some pharmaceutical companies to consider developing drugs abroad, it's important to understand the additional risks and compliance requirements associated with conducting clinical studies in other countries, say attorneys at Morgan Lewis.

  • Compliance Lessons From Warby Parker's HIPAA Fine

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    The U.S. Department of Health and Human Services' civil money penalty against Warby Parker highlights the emerging challenges that consumer-facing brands encounter when expanding into healthcare-adjacent sectors, with Health Insurance Portability and Accountability Act compliance being a potential focus of regulatory attention, say attorneys at Saul Ewing.

  • 5th Circ. Ruling Is Latest Signal Of Shaky Qui Tam Landscape

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    In his recent concurring opinion in U.S. v. Peripheral Vascular Associates, a Fifth Circuit judge joined a growing list of jurists suggesting that the False Claims Act's whistleblower provisions are unconstitutional, underscoring that acceptance of qui tam relators can no longer be taken for granted, say attorneys at Miller & Chevalier.

  • Medicare Advantage Enforcement Strong Amid Agency Cuts

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    The second Trump administration's actions thus far suggest that Medicare Advantage enforcement remains a bipartisan focus despite challenges presented by evolving trends in federal agency staffing and resources, say attorneys at Ropes & Gray.

  • A New Tool For Assessing Kickback Risks In Health Marketing

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    The Seventh Circuit's recent decision in U.S. v. Sorensen, reversing a conviction after trial of a durable medical equipment distributor, highlights two principle considerations for determining whether payments to marketers in healthcare are unlawful under the Anti-Kickback Statute, says Elisha Kobre at Sheppard Mullin.

  • How Trump Orders Affect Health Orgs.' Care For Trans Minors

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    Two recent executive orders issued by President Donald Trump regarding gender-affirming care for minors have put healthcare organizations in a precarious situation, and these institutions should prepare for various implications and potential scenarios, say attorneys at ArentFox.

  • Reproductive Health Under Trump So Far, And What's Next

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    Based on priorities stated so far, the Trump administration will likely continue to weaken Biden-era policies that protect reproductive health, with abortion, in vitro fertilization and contraception all being issues to watch closely amid a post-Dobbs shift, say attorneys at McDermott.

  • What's Next For Lab Test Regulation Without FDA Authority

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    A recent Texas federal court decision vacating the U.S. Food and Drug Administration's final rule that would apply FDA regulations to laboratory-developed tests signals potential positive impacts in the diagnostic space, and could inspire more healthcare entities to litigate against the government, say attorneys at Hooper Lundy.

  • 6 Criteria Can Help Assess Executive Branch Actions

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    With new executive policy changes announced seemingly every day, several questions can help courts, policymakers and businesses determine whether such actions are proper, effective and in keeping with our democratic norms, say Marc Levin and Khalil Cumberbatch at the Council on Criminal Justice.

  • Learning From COVID-19 Enforcement Against Nursing Homes

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    Five years after the COVID-19 outbreak caused a high number of deaths in nursing homes, an examination of enforcement actions against nursing homes in New York and elsewhere in the country highlights obstacles that may arise when bringing cases of this type, and ways to overcome them, says Kenneth Levine at Stone & Magnanini.

  • How Plan Sponsors Can Mitigate Risk In PBM Contracts

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    A recent lawsuit in New York federal court alleges that JPMorgan caused exorbitant prescription costs by mishandling the pharmacy benefit manager arrangement, adding to a growing body of Employee Retirement Income Security Act fiduciary breach litigation and affirming that fiduciaries must proactively manage their healthcare plan vendors, say attorneys at Hall Benefits Law.