Policy & Compliance

  • November 21, 2025

    DC Judge Axes Teva Challenge To Drug Price Program

    A D.C. federal judge tossed a challenge by Teva Pharmaceuticals to the Medicare drug price negotiation program, marking the latest in a series of losses by drugmakers and trade groups seeking to upend the program.

  • November 21, 2025

    Fla. Wound Doctor Agrees To Pay $45M For Overbilling Claims

    A Florida doctor and his companies agreed to pay $45 million to settle a suit alleging he submitted fraudulent claims to Medicare for medically unnecessary wound care procedures, the U.S. government said Friday. 

  • November 21, 2025

    Colo. Healthcare System Stiffing Workers, Court Told

    A pair of former workers for a hospital and healthcare facility operator in Colorado have accused their past employer of routinely shortchanging their pay in violation of state and federal wage and hour laws, according to a proposed class action filed in federal court.

  • November 21, 2025

    PBMs Say Gov't Benefits From Drug Rebates FTC Condemns

    Caremark Rx, Express Scripts and OptumRx have been given permission to seek documents they say will show the government benefits from the same type of prescription drug rebating activity that's being targeted by the Federal Trade Commission's insulin pricing case.

  • November 21, 2025

    'No Evidence' New Info Backs J&J Unit's Libel Suit, Court Told

    A doctor being sued by Johnson & Johnson's bankrupt talc subsidiary pushed back on the unit's bid to revive its trade libel claim over a scientific article she wrote linking asbestos in talc to mesothelioma, arguing it failed to cite any evidence that undermines the court's finding that the article was a nonactionable statement of scientific opinion.

  • November 21, 2025

    Rothman Orthopaedics Hit With Pa. Wiretapping Lawsuit

    Rothman Orthopaedics has been hit with a proposed class action in Pennsylvania alleging the company violated state wiretapping laws by intercepting private healthcare information on its website using a third-party tracking pixel.

  • November 21, 2025

    Hyperbaric Chamber Death Suit Not Covered, Insurers Say

    Two Nationwide insurers said they have no duty to defend or indemnify a hyperbaric oxygen therapy center or its employees in a suit over the death of a 5-year-old boy, telling a Michigan federal court that there was no bodily injury or property damage caused by an occurrence, or accident.

  • November 21, 2025

    1st Circ. Clears IT Co. In Suit Over Zoll Patient Data Breach

    An information technology company cannot be held liable for a data breach exposing the health information of patients of a unit of medical device maker Zoll Medical Corp, the First Circuit ruled, because the two companies did not have a business relationship permitting them to hold one responsible for another's conduct.

  • November 20, 2025

    Pharma Cos. Seek Early Win In States' Price-Fixing Lawsuit

    A collection of states failed to prove an overarching conspiracy among 25 separate pharmaceutical companies to fix the prices of generic drugs, most of them dermatology formulations, the drugmakers argued Wednesday in support of a bid for an early win on one element of dozens of antitrust claims.

  • November 20, 2025

    5th Circ. Seeks Interpretation Of Miss. Health Decisions Law

    A Fifth Circuit panel asked the Mississippi Supreme Court on Thursday to clarify an "ambiguous" state law that sets out which family members can act as surrogates and make healthcare decisions for relatives without the capacity to decide for themselves.

  • November 20, 2025

    Ala. County Must Face Inmate Death Claim, 11th Circ. Rules

    An Eleventh Circuit panel ruled Thursday that no Alabama state law prevents a county from facing liability for an incarcerated person's death after substandard healthcare from a third-party medical provider the county hired. 

  • November 20, 2025

    Blue Shield Of California, Magellan Sued Over 'Ghost Network'

    Blue Shield of California and Magellan Health maintain a "ghost network" directory of mental health providers who don't exist or don't accept new patients, leading customers to hit a dead end or desperately resort to expensive out-of-network providers, according to a proposed class action filed Wednesday in California federal court. 

  • November 20, 2025

    10th Circ. Weighs Colo. Law On Healthcare Sharing Plans

    A Tenth Circuit panel grappled Thursday with how the court should interpret a Colorado law requiring entities not authorized to offer insurance in the state to report certain information about their healthcare sharing plans, in an appeal by a religious trade group challenging the law's constitutionality.

  • November 20, 2025

    Claims Firms Barred From Misleading Plaintiffs In Pharma MDL

    On the same day that a Philadelphia federal judge approved $58 million in settlements as part of an ongoing generic-drug price-fixing multidistrict litigation, she also ordered several claims recovery firms to correct allegedly false and misleading ads used to attract potential clients seeking to make claims on the settlements.

  • November 19, 2025

    Senior Living Co. Inks $7.2M Deal To End Wash. AG's Probe

    Oregon-based senior living provider Bonaventure will invest $7 million in staffing and upgrades and shell out $200,000 in resident credits to resolve allegations of substandard care at 10 Washington state facilities, under a settlement filed Wednesday.

  • November 19, 2025

    Is 'Red Book' Best For Drug Pricing? Pa. Justices Ask

    The Pennsylvania Supreme Court seemed skeptical Wednesday that the state workers' compensation authorities were using the best guide to calculate pharmacy reimbursements for injured workers' prescription drugs, with the justices questioning the fairness of the industry's long-used "red book" method.

  • November 19, 2025

    11th Circ. Backs Kaiser In Air Ambulance Arbitration Dispute

    The Eleventh Circuit on Wednesday declined an air ambulance company's bid to scrap an arbitrator's ruling that Kaiser only owes $24,000 for an emergency helicopter flight, rejecting the emergency medical provider's arguments that the insurer committed fraud by strategically lowballing the arbitrator.

  • November 19, 2025

    Aetna Gets OK For $3.4M Deal In Cancer Treatment Denial Suit

    A Florida federal judge has signed off on Aetna's $3.4 million settlement agreement resolving a class action that alleged the insurer unlawfully mischaracterized a proton beam cancer radiation treatment as experimental to deny dozens of claims.

  • November 19, 2025

    Senate GOP Resists Extending Expanded ACA Tax Premiums

    Senate Finance Committee Democrats on Wednesday urged their Republican counterparts to extend the enhanced tax credits for the Affordable Care Act, which is set to expire at the end of the year, but Republicans said they were looking for other options to address rising healthcare costs.

  • November 19, 2025

    Conn. Dentists Pay $714K To Settle Patient Kickback Claims

    Two Connecticut dentists will pay more than $714,000 to the state and federal governments to settle joint allegations that their practices submitted false government benefits claims that contained kickbacks for patient recruiters.

  • November 19, 2025

    Pa. Health Network's $1.15M 401(k) Suit Deal Gets Initial OK

    A healthcare system Wednesday secured initial approval from a Pennsylvania federal court for a $1.15 million settlement agreement that would resolve a proposed class action alleging the company misused forfeited retirement plan funds and allowed the plan's administrative costs to soar.

  • November 19, 2025

    Whoop Blood Pressure Tracker Hit With False Ad Suit

    A consumer on Tuesday hit health and wellness wearable tech company Whoop Inc. with a proposed class action in California federal court alleging that its boasting of the blood pressure features of its fitness tracker duped consumers and prompted a warning from health regulators.

  • November 19, 2025

    Hospice Co. Should Face Tobacco Fee Suit, Judge Says

    A hospice and home healthcare provider shouldn't escape a proposed class action challenging a tobacco surcharge in its employee health plan, a Pennsylvania federal judge recommended, finding that allegations sufficiently backed up that a wellness program implementing the fee didn't meet all regulatory requirements.

  • November 19, 2025

    Doctor, Husband Admit $16M Healthcare Fraud, Tax Evasion

    A physician and her husband admitted to committing more than $16 million in healthcare fraud and tax evasion as part of a scheme that injected sick patients with the wrong medications or dosages, according to their plea agreements in Alaska federal court.

  • November 19, 2025

    COVID-19 Testing Co. Settles Wage Suit With Testers, Drivers

    A COVID-19 mobile testing company told a New York federal court that it has reached a settlement with a group of testers and drivers who claimed they were not paid full wages and overtime.

Expert Analysis

  • 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.

  • High Court ACA Ruling May Harm Preventative Care

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    The U.S. Supreme Court's decision in Kennedy v. Braidwood last week, ruling that the U.S. Department of Health and Human Services secretary has authority over an Affordable Care Act preventive care task force, risks harming the credibility of the task force and could open the door to politicians dictating clinical recommendations, says Michael Kolber at Manatt.

  • Rising Enforcement Stakes For Pharma Telehealth Platforms

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    Two pieces of legislation recently introduced in Congress could transform the structure and promotion of telehealth arrangements as legislators increasingly scrutinize direct-to-consumer advertising platforms, potentially paving the way for a new U.S. Food and Drug Administration policy with bipartisan support, say attorneys at Sheppard Mullin.

  • 3 Judicial Approaches To Applying Loper Bright, 1 Year Later

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    In the year since the U.S. Supreme Court overturned Chevron deference in its Loper Bright Enterprises v. Raimondo decision, a few patterns have emerged in lower courts’ application of the precedent to determine whether agency actions are lawful, say attorneys at Husch Blackwell.

  • How Providers Can Brace For Drug Pricing Policy Changes

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    Though it's uncertain which provisions of the Trump administration's executive order aimed at addressing prescription drug costs will eventually be implemented, stakeholders can reduce potential negative outcomes by understanding pathways that could be used to effectuate the order's directives, say attorneys at McDermott.

  • Debunking 4 Misconceptions Around Texas' IV Therapy Law

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    Despite industry confusion, an IV therapy law enacted in Texas last week may actually be the most business-friendly regulatory development the medical spa industry has seen in recent years, says Keith Lefkowitz at Hendershot Cowart.

  • Legacy Of 3 Justices Should Guide Transgender Rights Ruling

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    Three Republican-appointed U.S. Supreme Court justices — Anthony Kennedy, Sandra Day O'Connor and David Souter — gave rise to a jurisprudence of personal liberty that courts today invoke to protect gender-affirming care, and with the court now poised to decide U.S. v. Skrmetti, it must follow the path that they set, says Greg Fosheim at McDermott.

  • Recent Reports Shed Light On Section 340B's Effectiveness

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    Recent analyses of the Section 340B program's effectiveness in helping patients afford drugs in Minnesota reinforce concerns about the program's lack of transparency and underscore the need for further evaluation of whether legislative reform should be enacted, say William A. Sarraille at the University of Maryland, and Andrée-Anne Fournier and Molly Frean at Analysis Group.

  • What Parity Rule Freeze Means For Plan Sponsors

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    In light of a District of Columbia federal court’s recent decision to stay litigation challenging a Mental Health Parity and Addiction Equity Act final rule, as well as federal agencies' subsequent decision to hold off on enforcement, attorneys at Morgan Lewis discuss the statute’s evolution and what plan sponsors and participants can expect going forward.

  • CMS Guidance May Complicate Drug Pricing, Trigger Lawsuits

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    Recent draft guidance from the Centers for Medicare & Medicaid Services proposes to expand the scope of what counts as the same qualifying single-source drug, which would significantly alter the timeline for modified drugs facing price controls and would likely draw legal challenges from innovator drug companies, say attorneys at Debevoise.

  • 3 Takeaways From Recent Cyberattacks On Healthcare Cos.

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    For the healthcare industry, the upward trend in styles of cyberattacks, costs, and entities targeted highlights the critical importance of proactive planning to help withstand the operational, legal and reputational turmoil that can follow a data breach, say attorneys at Troutman Pepper.

  • Most-Favored Nation Drug Pricing Could Shake Up US Pharma

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    Recent moves from the executive and legislative branches represent a serious attempt to revive and refine the first Trump administration's most-favored-nations model for drug pricing, though implementation could bring unintended consequences for pharmaceutical manufacturers and will likely draw significant legal opposition, say attorneys at Morgan Lewis.