Policy & Compliance

  • July 02, 2026

    CMS Proposes Cut To Hospitals' 340B Drug Reimbursements

    Federal health officials on Thursday proposed a Medicare spending plan that would slash reimbursement for hospitals participating in the 340B drug pricing program and reduce how much all hospitals receive for certain imaging tests.

  • July 01, 2026

    Alibaba Cos. Ink $600M Nonprosecution Deal Over Drug Sales

    Alibaba Group Holding Ltd. and its U.S.-based payment processor AUS Merchant Services Inc. will avoid prosecution and pay $600 million to end the U.S. Department of Justice's allegations that they allowed merchants to sell and import illegal pharmaceuticals and controlled substances into the U.S., the DOJ announced Wednesday.

  • July 01, 2026

    Big Pharma Cos. Want 340B Drug Price FCA Suit Tossed

    Four major pharmaceutical companies Wednesday urged a California federal court to toss False Claims Act allegations revived by the Ninth Circuit claiming they filed false ceiling prices for drugs and overcharged entities covered by a federal discount program, saying the suit is precluded by the FCA's public disclosure bar.

  • July 01, 2026

    Gov't Officials Tout Unprecedented Healthcare Fraud Push

    It's been an unprecedented year for healthcare fraud enforcement, senior government officials from the U.S. Justice Department and Department of Health and Human Services told conference attendees gathered in a ballroom Wednesday morning at the Midtown Hilton in Manhattan.

  • July 01, 2026

    Amgen Wins Order Blocking Colorado's Enbrel Price Cap

    Colorado is preliminarily blocked from enforcing its price cap on Amgen's rheumatoid arthritis drug Enbrel, a federal judge ruled Wednesday, saying the biotech company is likely to succeed on its claim that federal patent law preempts the state's effort to limit the price of patented medications.

  • July 01, 2026

    8th Circ. Keeps Missouri's 340B Contract Pharmacy Law Alive

    The Eighth Circuit declined Wednesday to temporarily block a Missouri law that bars drugmakers from imposing restrictions on federally funded providers that contract with pharmacies to distribute discount drugs in the 340B drug discount program.

  • June 30, 2026

    Health Attys Talk Cooperation In Gov't Fraud Investigations

    For attorneys defending healthcare clients hit with grand jury subpoenas and other enforcement actions investigating potential cases of fraud, cooperation with federal prosecutors is key.

  • June 30, 2026

    AIDS Group Says Cigna-Owned Express Scripts Hurts Patients

    AIDS Healthcare Foundation says its nonprofit wellness centers are going to be run out of business if Cigna-owned pharmacy benefit manager Express Scripts isn't stopped from using its muscle in the market to steer pharmacy patients toward specialty pharmacies it's affiliated with.

  • June 30, 2026

    What To Know As Sen. Cassidy Proposes Changes To 340B

    Newly introduced Senate legislation could radically change the scope of the 340B drug discount program, including by altering how providers tap discounts and provider deals with pharmacies.

  • June 30, 2026

    Remedies, Not Suits: How FTC Approaches Health Mergers

    The Federal Trade Commission has not sued over any healthcare provider mergers since President Donald Trump's return to the White House. Attorneys at the American Health Law Association annual meeting say that's not a signal that the agency is backing off.

  • June 30, 2026

    Judge To Mull Surgeon's Dismissal Bid In 'No Surprises' Suit

    A New Jersey court will soon decide whether allegations that a plastic surgeon abused No Surprises Act arbitration can move forward. Law360 looks at a closely watched case testing what role courts play in this and other NSA disputes.

  • June 30, 2026

    Cigna, Others Fight Ohio AG's Drug Price-Fixing Suit

    Ohio pharmacy benefit managers and their corporate parents urged a federal judge to toss the state's drug price-fixing lawsuit, saying in a series of briefs that the state is trying to skirt federal pleading standards, collapse corporate separateness and stretch Ohio's antitrust law beyond its limits.

  • June 30, 2026

    GEO Still Blocking Parts Of NJ Detention Center, State Says

    New Jersey and its Department of Health told a federal judge that despite consent from U.S. Immigration and Customs Enforcement to tour its Newark detention center, facility operator GEO Group Inc. is still barring entrance to certain areas.

  • June 30, 2026

    Patience Thin On Bench For Dragged-Out FCA Probes

    Judicial frustration was on display in recent rulings in which judges took issue with repeated DOJ requests for sealed records. A desire to speed up fraud cases factors into a fish-or-cut-bait policy for federal prosecutors.

  • June 29, 2026

    Feds Sue Mich., Other States For Not Sharing SNAP Records

    The U.S. Department of Justice is asking federal courts to force Kentucky, Michigan, Minnesota and Pennsylvania to turn over their Supplemental Nutrition Assistance Program applicant data that the Trump administration claims it needs to uncover billions of dollars in overpayments and fraud.

  • June 29, 2026

    26 States Sue To Nix Medicaid Work Rule For Medically Frail

    More than two dozen states sued the Trump administration Monday in Massachusetts federal court in a bid to strike down new Medicaid work requirements for certain enrollees, saying the administration did not consider the consequences the requirements would have on vulnerable Medicaid enrollees.

  • June 29, 2026

    AstraZeneca To Pay $34M In Texas Kickbacks Settlement

    AstraZeneca has agreed to pay nearly $34 million to the state of Texas to put to rest allegations the pharmaceutical company gave kickbacks to providers for prescribing its drugs, many of which were covered by the Lone Star State's Medicaid program, according to an announcement made Monday.

  • June 29, 2026

    Hospital That Halted Gender Care Must Show Cause

    A Colorado state court judge issued a citation on Friday to Children's Hospital Colorado ordering it to show cause for why the hospital refuses to provide gender-affirming care to patients in violation of a preliminary injunction order issued by the Colorado Supreme Court. 

  • June 29, 2026

    Insurers Seek NJ Mass Tort For No Surprises Act Suits

    Five of the largest health insurers in the Garden State have asked the New Jersey Supreme Court to designate 160 pending cases seeking the enforcement of alleged independent dispute resolution payment determinations issued under the federal No Surprises Act as multicounty litigation, according to a notice to the Bar Association.

  • June 29, 2026

    8th Circ. Backs Tossing Ark. Worker's Pharmacy Network Suit

    The Eighth Circuit on Monday turned down an employee health plan participant's bid to revive a proposed class action alleging CVS Caremark unjustly enriched itself by failing to comply with Arkansas laws on pharmacy network adequacy, holding a lower court didn't err in tossing the dispute.

  • June 29, 2026

    Supreme Court To Review Wash. Youth Gender Care Law

    The U.S. Supreme Court will hear a challenge to Washington state's law permitting shelters not to notify the parents of runaway teens who seek gender-affirming treatment, reviving a lawsuit that a Ninth Circuit panel unanimously shot down after a district judge found the plaintiffs could only show speculative injury.

  • June 29, 2026

    Justices Skip New York Health Workers' Fight Over Vax Rule

    The U.S. Supreme Court refused Monday to take up religious healthcare workers' challenge to a pandemic-era New York state policy requiring healthcare providers to make their employees get vaccinated against COVID-19, drawing a dissent from Justices Neil Gorsuch, Clarence Thomas and Samuel Alito.

  • June 26, 2026

    Conn. Provider Must Share Takeover Data After $49M Verdict

    A Connecticut state court has ordered Westchester Medical Group PC to produce corporate takeover documents and leadership information as the court contemplates the provider's bid to set aside a $49 million jury verdict over claims its staff failed to diagnose a woman with cervical cancer.

  • June 26, 2026

    En Banc 4th Circ. Splits Over Stay Of DOD HIV Enlistment Ban

    The Fourth Circuit voted en banc Thursday to grant the federal government's bid to pause a lower court's permanent injunction blocking its policies excluding HIV-positive individuals from enlisting in the military, with a dissenting appellate judge writing that "the government is playing games!"

  • June 26, 2026

    DC Circ. Backs CMS In Medicare Advantage Rating Fight

    A D.C. Circuit panel on Friday upheld the Centers for Medicare & Medicaid Services' calculation of a Louisiana insurer's Medicare Advantage star rating, rejecting the insurer's claims that the agency unlawfully included data from a contract that had been folded into another one.

Expert Analysis

  • Federal Grantees May Soon Face More Limitations On Speech

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    If courts accept the administration’s new interpretation of preexisting case law, which attempts to graft onto grant recipients the existing limitations on government contractors' free speech, a more deferential standard may soon apply in determining whether an agency’s refusal or termination of a grant was in violation of the First Amendment, say attorneys at Venable.

  • HHS Wound Care Report Highlights Need For Payment Reform

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    The U.S. Department of Health and Human Services' recent report on potential abuse in Medicare Part B payments for skin substitutes highlights specific fraud schemes, but more importantly emphasizes that broader changes are needed for the wound care sector's fundamentally flawed payment system, say attorneys at Paul Hastings.

  • Assessing The Future Of The HIPAA Reproductive Health Rule

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    In light of a Texas federal court's recent decision to strike down a U.S. Department of Health and Human Services rule aimed to protect the privacy of patients seeking abortions and gender-affirming care, entities are at least temporarily relieved from compliance obligations, but tensions are likely to continue for the foreseeable future, says Liz Heddleston at Woods Rogers.

  • DOJ's Tracing Rule For Pandemic Loan Fraud Is Untenable

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    In conducting investigations related to COVID-19 relief fraud, the government's assertion that loan proceeds are nonfungible and had to have been segregated from other funds is unsupported by underlying legislation, precedent or the language establishing similar federal relief programs, say Sharon McCarthy, Jay Nanavati and Lasya Ravulapati at Kostelanetz.

  • New Health AI Guidance Features A Provider-Centric Approach

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    New guidance from the Joint Commission and Coalition for Health AI regarding the responsible use of artificial intelligence in healthcare deviates from preexisting guidance by recommending a comprehensive framework for using AI tools, focusing on healthcare provider organizations rather than on AI developers, say attorneys at Ropes & Gray.

  • Mass. Ruling May Pave New Avenue To Target Subpoenas

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    A Massachusetts federal court’s recent decision to quash a subpoena seeking information on gender-affirming care at Boston Children’s Hospital is a significant departure from courts' deferential approach to subpoena enforcement, and may open a new pathway for practitioners challenging investigative tools in the future, say attorneys at Gibson Dunn.

  • What To Expect After FDA Warnings To GLP-1 Compounders

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    The U.S. Food and Drug Administration's recent warning letters to companies advertising compounded versions of GLP-1 medications raise questions not just about the enforcement outlook for marketing such products, but also about the future of drug compounding as a whole, say attorneys at Spencer Fane.

  • How Financial Cos. Can Prep As NYDFS Cyber Changes Loom

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    Financial institutions supervised by the New York State Department of Financial Services can prepare for two critical cybersecurity requirements relating to multifactor authentication and asset inventories, effective Nov. 1, by conducting gap analyses and allocating resources to high-risk assets, among other steps, say attorneys at Pillsbury.

  • How Courts May Interpret Data-Driven Healthcare Fraud Suits

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    As the U.S. Department of Justice and other agencies increasingly turn to data mining as an enforcement tool, courts will have to determine how far data alone can take a fraud case, and sound theory, clinical expertise and institutional context will play an important role, say Jaime Jones at Sidley and Andrée-Anne Fournier and Atang Gilika at Analysis Group.

  • How Gov't Shutdown Will Affect Federal Health Agencies

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    Federal health agencies' contingency plans indicate that many major programs will remain insulated from disruption during the ongoing government shutdown, but significant policy proposals will likely be delayed and the Trump administration's emphasis on reduction-in-force plans distinguishes this shutdown from past lapses, says Miranda Franco at Holland & Knight.

  • Assessing Legal, Regulatory Hurdles Of Healthcare Offshoring

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    The offshoring of administrative, nonclinical functions has emerged as an increasingly attractive option for healthcare companies seeking to reduce costs, but this presents challenges in navigating the web of state restrictions on the access or storage of patient data outside the U.S., say attorneys at McDermott.

  • 5 Years In, COVID-19 Fraud Enforcement Landscape Is Shifting

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    As the government moves pandemic fraud enforcement from small-dollar individual prosecutions to high-value corporate cases, and billions of dollars remain unaccounted for, companies and defense attorneys must take steps now to prepare for the next five years of scrutiny, says attorney David Tarras.

  • Courts Keep Upping Standing Ante In ERISA Healthcare Suits

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    As Article III standing becomes increasingly important in litigation brought by employer-sponsored health plan members under the Employee Retirement Income Security Act, several recent cases suggest that courts are taking a more scrutinizing approach to the standing inquiry in both class actions and individual matters, say attorneys at Crowell & Moring.