Policy & Compliance

  • August 12, 2026

    9th Circ. Says Aetna Must Face Benefit Misrepresentation Suit

    The Ninth Circuit revived allegations that Aetna misrepresented how much it would pay toward a patient's $150,000 surgery, finding that federal benefits law didn't preempt a claim brought under state law because the dispute centered on the payment commitments rather than the health plan itself.

  • August 12, 2026

    CMS Ends Medicaid Funds For Youth Transgender Care

    Medicaid will no longer cover the cost of some gender-affirming care for minors, including gender reassignment surgery and hormone treatments, the Centers for Medicare and Medicaid Services announced after issuing a final rule set to take effect this year. 

  • August 11, 2026

    CMS Fraud Concerns Drive Call For Autism Therapy Audits

    Healthcare providers who work with autistic people are facing greater scrutiny from the federal government over fraud concerns. Experts say the drivers of ballooning costs are complex.

  • August 11, 2026

    Fed. Circ. Revives Man's Vax Injury Case, Citing Mail Delay

    The Federal Circuit reversed a U.S. Court of Federal Claims decision that rejected a man's case seeking vaccine injury compensation, concluding that the court wrongly faulted him for the late arrival of his petition.

  • August 11, 2026

    Judge Probes 7th Circ. Fallout Of Ending Gender Care Fight

    An Illinois federal judge questioned Tuesday what would become of a pending appeal before the full Seventh Circuit if he allows the American Academy of Pediatrics to voluntarily dismiss, without prejudice, its challenge to a Florida racketeering probe over the medical group's gender-affirming care guidelines, an issue one attorney predicted would be "hotly contested."

  • August 11, 2026

    What To Know About Hartford HealthCare Privilege Row

    Hartford HealthCare, a Teamsters health insurance plan and a transit district are heading to court to argue over whether Hartford must produce documents in an antitrust lawsuit accusing the hospital group of exercising monopoly power.

  • August 11, 2026

    DOJ Drops 3rd Circ. Bid For Pa. Hospital Trans Patient Info

    The U.S. Department of Justice has dropped its request for the Third Circuit to review a district court's order quashing its demand for records on patients who received gender-affirming care at a University of Pittsburgh Medical Center children's hospital, effectively ending its subpoena fight in the district.

  • August 11, 2026

    Ga. Justices Call For Balancing Privacy Rights In Herpes Suit

    Georgia's top court ruled Tuesday that the privacy rights of a man accused of giving his ex-girlfriend genital herpes must be balanced against her interest in obtaining medical records to support her claims, resolving what the justices called a novel question.

  • August 10, 2026

    Spa Fights 9th Circ.'s 'Swinging Dicks' Order At High Court

    The Ninth Circuit's rejection of a spa's religious objections to serving transgender customers is incompatible with several major precedents, according to a U.S. Supreme Court petition filed Monday in litigation that soared in prominence when dozens of circuit judges decried a salacious dissent.

  • August 10, 2026

    Pharma Co. To Pay $46M Over Transplant Drug Kickbacks

    Veloxis Pharmaceuticals Inc. will enter a deferred prosecution agreement and pay more than $46 million to resolve criminal and civil allegations that the North Carolina-based drug manufacturer paid kickbacks to spur prescriptions and purchases of its kidney transplant immunosuppression drug Envarsus XR, the U.S. Department of Justice announced Monday.

  • August 10, 2026

    Drugmakers Lose 2nd Bid To Appeal Ex-Prosecutor DQ Rebuff

    A former Connecticut prosecutor and his current firm Lowey Dannenberg PC can keep representing insurers Humana Inc. and Molina Healthcare Inc. in an antitrust lawsuit against generic-drug makers, after the judge overseeing the multidistrict litigation rejected a second attempt to appeal her denial of disqualification.

  • August 10, 2026

    Trump Revives Push To Reduce Kids' Vaccine Schedule

    Responding to a legal setback, President Donald Trump signed an executive order Monday recommending fewer vaccines for most children and calling on parents and doctors to space out the vaccines they do give.

  • August 10, 2026

    Clinics' Suit Over Fund Use Ballot Measure Gets Tossed

    A California federal judge tossed a suit that federally designated community health clinics filed to block the placement of an expenditure transparency reporting initiative on the November ballot, saying the clinics' claims aren't ripe for court review.

  • August 10, 2026

    Arkansas Medical System Escapes Target-Date 401(k) Suit

    An Arkansas federal judge on Monday dismissed a proposed class action alleging Arkansas medical system Washington Regional mismanaged the system's employee 401(k) plan, holding that allegations of underperforming investment funds weren't backed up with enough comparisons to better-performing ones to state a claim for violating federal benefits law.

  • August 07, 2026

    ERISA Recap: 6 Important Rulings From July

    The Ninth Circuit rejected a fund manager's bid to force a 401(k) suit into arbitration, a district court tossed a pension de-risking suit, and the D.C. Circuit unraveled a union pension fund's $13 million withdrawal liability win.

  • August 06, 2026

    SEC Nets Win In Suit Over Ex-CEO's Alleged Revenue Scheme

    A Washington, D.C., federal judge on Thursday largely sided with the U.S. Securities and Exchange Commission in its civil enforcement case against the former CEO of RTI Surgical Holdings, finding he misled investors by failing to disclose that the surgical implant company regularly shipped orders early to artificially inflate its quarterly revenues.

  • August 06, 2026

    SpineFrontier CFO Sentenced To 4 Months In Kickback Case

    The former chief financial officer of spinal implant startup SpineFrontier was sentenced Thursday to four months in prison for his involvement in an alleged conspiracy to pay surgeons kickbacks disguised as consulting fees.

  • August 06, 2026

    7th Circ. Backs Outcome Health Execs' $1B Fraud Convictions

    The Seventh Circuit on Thursday upheld the convictions of two Outcome Health executives for lying about the company's capabilities and value in a $1 billion fraud, rejecting their argument that an overzealous pretrial freeze on millions in assets violated their constitutional right to hire the defense attorneys of their choice.

  • August 06, 2026

    GOP Sens. Vote To Hold Fauci In Contempt, AGs Open Probe

    A U.S. Senate committee voted along party lines Thursday to hold Dr. Anthony Fauci in contempt of Congress after he declined to answer questions about the government's handling of the pandemic, while the Florida, West Virginia and Louisiana attorneys general are investigating potential "self-dealing" by Fauci during the crisis.

  • August 06, 2026

    Cigna Wins Dismissal Of Pa. In-Network Pharmacy Suit

    A Pennsylvania federal judge on Thursday dismissed a suit against Cigna, Evernorth and Express Scripts from Pennsylvania pharmacy customers who alleged injury because the companies designated their community pharmacy as out-of-network, holding state-law claims were preempted by federal benefits law but allowing another chance at re-pleading.

  • August 06, 2026

    Data Breach Case Against Allegheny Health Mostly Advances

    A Pennsylvania federal judge cleared most of a data breach class action against Allegheny Health System to move forward, leaving the healthcare company and its information technology vendor to face allegations that they are liable for allowing patients' sensitive information stored on internal networks to be compromised by a hacker.

  • August 06, 2026

    Eli Lilly, Novo Nordisk Antitrust Suit Tossed By Texas Judge

    A Texas federal court has dismissed compounding pharmacy Strive Specialties Inc.'s antitrust lawsuit against Eli Lilly and Novo Nordisk, finding it failed to allege the companies blocked competition for GLP-1 medications.

  • August 05, 2026

    Drug Cos. Can't Trim Humana's Price-Fix Claims In Bellwether

    A Pennsylvania federal judge on Tuesday denied a bid by a number of generic drug manufacturers to dismiss two antitrust claims brought by health insurer Humana Inc. from an upcoming bellwether trial in long-running antitrust multidistrict litigation, finding they were brought within the statute of limitations.

  • August 05, 2026

    Kansas Judge Permanently Blocks Abortion Care Restrictions

    A Kansas state court has permanently enjoined a slew of restrictions on abortion care, including requirements that providers disclose patients' reasons for seeking an abortion to the state and inform patients about abortion pill "reversal" treatments the court said were "unlikely to be biologically plausible."

  • August 05, 2026

    No Coverage For Assisted Living Death, Fla. Panel Says

    A Florida appellate court on Wednesday reversed a judgment that required National Assisted Living Risk Retention Group to provide coverage for a wrongful death suit from a resident's 2012 death, finding no claim was made during the relevant policy period.

Expert Analysis

  • NY Opioid Antagonist Mandate Leaves Employers Guessing

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    A recently enacted New York law will require employers that are federally mandated to maintain first-aid supplies to now include an opioid antagonist, but being that it is subject to a complicated Occupational Safety and Health Administration analysis, employers face several unanswered compliance questions, say attorneys at Conn Maciel.

  • Calif. Case Raises Questions For Medical Practice Investors

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    The California attorney general's amicus brief in Art Center v. WCE and the California Medical Association's response highlight how the California appeals court's ruling could significantly affect the structure and enforceability of succession arrangements in medical practice ownership, say attorneys at Ropes & Gray.

  • Previewing FDA Preapproval Access In Psychedelics EO

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    The second of two pathways for psychedelic drug access outlined in President Donald Trump's recent executive order constitutes an unprecedented expansion of the Right to Try Act, which could fundamentally alter the psychedelic access landscape while presenting significant regulatory, operational and legal challenges, say attorneys at Husch Blackwell.

  • Previewing FDA National Priority Vouchers In Psychedelics EO

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    President Donald Trump's recent executive order on psychedelic drug access represents a watershed moment in federal drug policy, but its significance lies in two distinct regulatory pathways, the first being the Commissioner's National Priority Vouchers, which offer a significant opportunity to compress U.S. Food and Drug Administration review, say Kimberly Chew at Husch Blackwell and Odette Hauke at Odette Alina.

  • AG Watch: Texas Charts A Course On Investigative Authority

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    The Texas Supreme Court's recent decision in Texas v. PFLAG affirmed, and arguably expanded, the Texas attorney general's civil investigative demand authority, providing a road map that other courts evaluating state attorney general CIDs may find instructive, amid a lack of precedent, say attorneys at Kelley Drye.

  • Initial Virginia AG Actions Signal Focus On Multistate Efforts

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    Now that Virginia Attorney General Jay Jones has reached the 100-day mark in office, his first set of actions reveals a clear preference for coalition with regional and national counterparts, which means the primary risk for businesses is no longer just the fact of enforcement, but the speed at which investigations can escalate, says Lauren Cooper at Hogan Lovells.

  • How CMS Fraud Priorities Complicate Provider Acquisitions

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    As the Centers for Medicare & Medicaid Services steps up usage of its affiliates authority and post-transaction audits, parties contemplating the acquisition or sale of home health and hospice providers should take steps to avoid the potential suspension of Medicare billing privileges, say attorneys at Alston & Bird.

  • Mapping Philly US Atty's White Collar Enforcement Push

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    Attorneys at Blank Rome discuss the U.S. Attorney for the Eastern District of Pennsylvania David Metcalf’s commitments and priorities, survey early results from his first year, and suggest practical action items for companies operating under the office's jurisdiction.

  • How The Coming Months Will Shape State Drug Price Boards

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    The future of state prescription drug affordability boards may be determined in the next few months, between an upcoming court decision in a challenge against state authority to set drug prices, and pending state decisions about whether to use federal Medicare maximum fair prices as reference, say Michael Kolber, Steven Chen and Kelechi Ezealaji at Manatt.

  • Steps To Consider As DOJ Launches Fraud Division

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    The establishment this month of the National Fraud Enforcement Division within the U.S. Department of Justice is a significant reorganization that suggests an increase in enforcement activity involving federally funded programs but leaves a number of important questions unanswered, say attorneys at Crowell & Moring.

  • Court's HRSA Policy Reversal Leaves 340B Rules Murky

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    A D.C. federal court's recent decision in Premier v. U.S. Department of Health limits the Health Resources and Services Administration's ability to enforce long-standing Section 340B interpretations through subregulatory guidance, leaving open core statutory questions about purchasing models, inventory classification and program oversight, says Martha Cramer at Hooper Lundy.

  • Fresenius Ruling May Shift Anti-Kickback Enforcement

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    The Ninth Circuit's recent decision in Fresenius v. Bonta suggests that businesses have a First Amendment right to donate to certain charities, even if those donations are motivated by economic self-interest, potentially calling into question years of Anti-Kickback Statute proceedings against pharmaceutical manufacturers for making similar donations, says Jonah Knobler at Patterson Belknap.

  • The Challenge Of Stabilizing Rural Hospitals On The Brink

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    The outlook for rural hospitals has grown more concerning, as recent policy and regulatory developments are decreasing hospital revenues and increasing the cost of uncompensated care, which may result in additional hospital closures, service reductions, or mergers and acquisitions, say Omur Celmanbet, Kristy Piccinini and Sabiha Quddus at FTI Consulting.