Policy & Compliance

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • October 08, 2025

    Trump Admin Challenges Denial Of Trans Care Subpoena

    The Trump administration told a Massachusetts federal judge that he got it wrong in quashing a subpoena for records of gender-affirming care at Boston Children's Hospital last month, urging the court to reconsider.

  • October 07, 2025

    Aetna COVID-19 Test Provider Sues Insurer For 'Unpaid' $53M

    A Nebraska company that provided COVID-19 testing for Aetna has filed suit in California federal court, alleging that the insurer owes it more than $53 million for testing services but has refused to pay up.

  • October 07, 2025

    Bausch And Teva Blocked Cheaper IBS Drug, Retailers Say

    A slew of retailers on Tuesday accused Bausch Health Cos. Inc. and Teva Pharmaceuticals of working together to keep the generic version of an irritable bowel syndrome drug off the market until 2028, forcing the retailers and other purchasers of the drug to pay monopoly prices.

  • October 07, 2025

    As Shutdown Continues, Hospital Attys Face Tired Clients

    As the government shutdown passes the one-week mark, hospital administrators facing potential financial hits and other heartache from the battle on Capitol Hill are getting tired.

  • October 07, 2025

    4th Circ. Urged To Reverse $10M Medicare Fraud Conviction

    A former physician's assistant on Tuesday requested that the Fourth Circuit reverse a six-year prison sentence for his involvement in a $10 million Medicaid fraud scheme, claiming evidence that could exonerate him was suppressed by a federal district court.

  • October 07, 2025

    DOJ Deal In Medicare Fraud Case A 'Slap On The Wrist'

    Healthcare startup Troy Medicare had big ambitions to revolutionize senior care in the Medicare Advantage market before justice officials learned that thousands of people were being fraudulently enrolled. A former Troy board member calls the company’s nonprosecution agreement a “slap on the wrist.”

  • October 07, 2025

    Drug Tax Outdoes Biblical Punishment, 5th Circ. Judge Says

    A Fifth Circuit panel pressed the U.S. Department of Health and Human Services to justify the basis for the Medicare drug pricing program's steep excise tax, asking Tuesday whether the government had ever levied a higher tax in the nation's history.

  • October 07, 2025

    9th Circ. Rejects 'Kitchen Sink' Challenge To Vaccine Mandate

    A Ninth Circuit panel on Monday upheld a lower court's rejection of a lawsuit brought by dozens of former employees of a nonprofit healthcare system who claimed Washington state's requirement that healthcare workers be vaccinated against COVID-19 violated their statutory and constitutional rights.

  • October 07, 2025

    Northwestern Wants ERISA Health Offering Suit Tossed

    Northwestern University asked an Illinois federal judge on Monday to throw out a proposed class action alleging it breached fiduciary duties in offering a higher-cost health plan alongside a cheaper option, arguing the plaintiffs have failed to allege injury because they admit that they received all the benefits to which they were entitled under the more-expensive plan's terms.

  • October 07, 2025

    Arizona Ruling Delivers Trans Victory Amid Federal Scrutiny

    A recent court order that bars Arizona from requiring proof of surgery before transgender people can change a birth certificate continues a trend of courts making it easier to amend vital records to match a person's gender identity.

Expert Analysis

  • CMS' New 'Breakthrough' Device Policy Shows Little Promise

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    The Centers for Medicare & Medicaid Services’ recent procedural notice outlining a new Medicare coverage pathway for breakthrough medical devices will, at best, be a failed experiment and, at worst, result in Medicare beneficiaries denied access to innovative treatments, say attorneys at King & Spalding.

  • A Preview Of AI Priorities Under The Next President

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    For the first time in a presidential election, both of the leading candidates and their parties have been vocal about artificial intelligence policy, offering clues on the future of regulation as AI continues to advance and congressional action continues to stall, say attorneys at Mintz.

  • Managing Community Health Needs Assessments: A Checklist

    Excerpt from Practical Guidance
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    To guide nonprofit hospitals and health systems through their required community health needs assessment every three years, this checklist outlines the steps for 12 phases of the process.

  • Pa. Health Employers Must Prep For Noncompete Restrictions

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    Newly enacted legislation in Pennsylvania prohibits certain noncompete covenants for healthcare practitioners in the state beginning next year, creating compliance challenges that both employers and employees should be aware of, say attorneys at Buchanan Ingersoll.

  • FTC Focus: What Access To Patent Settlements Would Mean

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    Settling parties should adopt a series of practice tips, including specifying rationales to support specific terms, as the Federal Trade Commission seeks to expand its access to settlements before the Patent Trial and Appeal Board, say Shannon McGowan and David Munkittrick at Proskauer.

  • Agencies Should Reward Corporate Cyber Victim Cooperation

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    The increased regulatory scrutiny on corporate victims of cyberattacks — exemplified by the U.S. Securities and Exchange Commission's case against SolarWinds — should be replaced with a new model that provides adequate incentives for companies to come forward proactively and collaborate with law enforcement, say attorneys at McDermott.

  • Strategies To Defend Against Healthcare Nuclear Verdicts

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    The healthcare industry is increasingly the target of megaclaims, particularly those alleging medical malpractice, but attorneys representing providers can use a few tools to push back on flimsy litigation and reduce the likelihood of a nuclear verdict, says LaMar Jost at Wheeler Trigg.

  • What Drug Cos. Must Know About NY Price Transparency Law

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    Drug manufacturers must understand the contours of New York's recently implemented law requiring self-reporting of drug price increases, as well as best practices for compliance and challenges against similar laws in other states, say Elizabeth Bierut and Angie Garcia at Friedman Kaplan.

  • Whistleblowers Must Note 5 Key Differences Of DOJ Program

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    The U.S. Department of Justice’s recently unveiled whistleblower awards program diverges in key ways from similar programs at other agencies, and individuals must weigh these differences and look first to programs with stronger, proven protections before blowing the whistle, say Stephen Kohn and Geoff Schweller at Kohn Kohn.

  • The Licensure Landscape For Psychedelics Manufacturers

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    As the need for bulk manufacturing of psychedelic substances grows, organizations aiming to support clinical trials or become commercial suppliers must navigate a rigorous and multifaceted journey to obtaining a license from the U.S. Drug Enforcement Administration, say Kimberly Chew at Husch Blackwell and Jaime Dwight at Promega Corp.

  • OSHA Workplace Violence Citation Highlights Mitigation Steps

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    The Occupational Safety and Health Administration's recent citation against behavioral health company Circles of Care sheds light on the enforcement risks companies may face for failing to prevent workplace violence, and is a reminder of the concrete steps that can help improve workplace safety, say attorneys at Benesch.

  • When Banks Unknowingly Become HIPAA Biz Associates

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    There appears to be significant confusion regarding the application of the Health Insurance Portability and Accountability Act to financial institutions when serving healthcare-related clients, so these institutions should consider undertaking several steps as a starting point in the effort to achieve compliance, say attorneys at Vorys.

  • The Regulatory Headwinds Facing Lab-Developed Tests

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    Though the U.S. Food and Drug Administration's final rule regarding regulation of laboratory-developed tests outlines a four-year plan for ending enforcement discretion, and though this rule is currently being challenged in courts, manufacturers should heed compliance opportunities immediately as enforcement actions are already on the horizon, say attorneys at Kirkland & Ellis.