Health Care

On January 30, 2026, the Department of Labor released a proposed rule (Proposed Rule) that would end long‑running confusion about how ERISA disclosure obligations apply to PBMs under the Consolidated Appropriations Act, 2021, and give fiduciaries of ERISA‑covered self‑insured group health plans significantly expanded visibility into PBM services and compensation. The proposal pairs broad compensation transparency with comprehensive audit rights covering PBMs and their affiliates, agents, and subcontractors, including PBM‑affiliated brokers and consultants.

The Proposed Rule and the Consolidated Appropriations Act, 2026, both of which were announced last week, will materially impact the PBM industry, particularly PBM’s arrangements with their plan clients. Below we provide an initial summary of the Proposed Rule’s key provisions and discuss its anticipated impact on PBMs, self-insured group health plans, and other stakeholders. 

On February 3, 2026, Congress passed – and the President signed – the Consolidated Appropriations Act, 2026 (2026 CAA). The legislation includes a long‑anticipated and far‑reaching package of PBM reforms. These reforms draw from the PBM Reform Act of 2025 and other legislative proposals and will significantly reshape PBM operations across the commercial market and Medicare Part D beginning in 2028–2029.

On January 22, 2026, the Department of Justice (DOJ or the Department) Criminal Fraud Section issued its 2025 Year in Review summary (YIR Summary). Our more detailed analysis of the full YIR Summary can be found here. DOJ’s Health Care Fraud Unit (the HCF Unit) is focused on “prosecuting complex health care fraud matters and cases involving the illegal prescription, distribution, and diversion of controlled substances.” To carry out its mission, in 2025, the HCF Unit operated 8 Health Care Fraud Strike Forces in 26 federal judicial districts across the nation. The HCF Unit’s reported average return on investment is $106.76 per $1 spent. 

As the telehealth industry is acutely aware, Medicare’s telehealth flexibilities and the Acute Hospital Care at Home Program, both of which have been in place since 2020, expired on January 31, 2026. While on that day the Senate passed a bipartisan minibus legislative package funding several federal agencies including the Department of Health and Human Services, the House was unable to immediately pass the legislation. As such, there has been a partial government shutdown – until now.

The Department of Justice's (DOJ or the Department) Criminal Fraud Section has undergone its most significant reorganization in years, according to its recently released 2025 Year in Review. Those changes and the current climate of enforcement uncertainty require more vigilance, not less, from corporate compliance and law departments.

The Office of Inspector General (OIG) for the Department of Health and Human Services’ most recent unfavorable Advisory Opinion is a stern reminder to healthcare organizations to consider the fraud and abuse risks of offering sign-on bonuses and other financial incentives to employees. Typically, sign-on bonuses and other forms of compensation to employees pose little fraud and abuse risk because the federal Anti-Kickback Statute (AKS) has a broad employment safe harbor that applies to any remuneration paid to employees, regardless of the compensation methodology. However, in this Advisory Opinion, the sign-on bonuses operated as advertisements for new patients and not just as a way to entice potential employees to join the organization. The OIG determined that sign-on bonuses structured in this manner do not satisfies the safe harbor and, if the requisite intent was present, would violate the AKS).

The January 2026 edition of FDA in Flux highlights significant developments shaping the regulatory landscape for medical, life sciences, and consumer product sectors.

Discover how health care organizations can prevent False Claims Act (FCA) retaliation claims. Learn best practices for compliance programs, whistleblower risk management, documentation protocols, and legal privilege strategies to reduce FCA litigation exposure.

Explore how AI is reshaping health care enforcement in 2026. Learn about emerging state regulations, federal oversight, enforcement risks, and best practices for compliance in an evolving AI-driven landscape.

Explore DOJ False Claims Act enforcement trends for 2025–2026 with insights from former US Attorney Erek Barron. Learn about data-driven investigations, AI risks, compliance strategies, and opportunities for self-disclosure.

Explore DOJ health care enforcement trends under Trump 2.0. Learn how leadership changes, new False Claims Act (FCA) priorities, and political initiatives like gender-affirming care investigations are reshaping compliance risks for 2026.

Explore how consumer protection regulators tackled health care issues in 2025, from GLP-1 weight loss drugs to AI oversight and pricing transparency. Learn what enforcement trends mean for health care companies in 2026.

Explore key constitutional challenges to the False Claims Act, including Article II disputes over qui tam provisions and Excessive Fines Clause litigation. Learn how recent court decisions impact FCA enforcement and penalty limits in 2026.

Learn the latest on EKRA enforcement and compensation rules for laboratory sales and marketing employees after the Ninth Circuit’s Schena decision. Explore DOJ’s stance, open compliance questions, and similar state law impacting clinical laboratories.

Learn how DOJ’s expanded Voluntary Self-Disclosure policy and evolving use of NPAs and DPAs create new opportunities for health care companies to resolve enforcement actions. Explore strategies for cooperation, remediation, and compliance.

Explore 2025 managed care enforcement trends under the Trump administration. Learn about DOJ and CMS priorities, Medicare Advantage risk adjustment cases, key cases interpreting regulatory changes, and compliance strategies for MAOs.

Discover key False Claims Act cybersecurity enforcement trends from 2025, including major DOJ settlements with defense contractors and health care companies. Learn best practices for compliance, self-disclosure, and risk mitigation as enforcement intensifies in 2026.

In September 2025, the New York State Assembly introduced Assembly Bill A9042, which would require veterinary clinics to provide notice and undergo Attorney General review for certain “material change” transactions, such as mergers or significant asset transfers. Momentum is building in 2026, with the bill recently referred to the Agriculture Committee for review on January 7th. This initiative builds on New York’s 2023 action to regulate healthcare transactions by requiring notice to the Department of Health for similar changes, but it goes further by extending oversight to the veterinary sector. Unlike most states, which primarily regulate ownership through bans on the corporate practice of veterinary medicine, the law would require formal notice and Attorney General review of certain transactions in the veterinary industry. As private equity investment continues to reshape veterinary care, this proposal could signal a broader trend toward increased regulation in 2026, potentially making New York the first state to set this precedent and raising the question of whether others will follow. This post will examine the bill’s key provisions and explore how current state laws govern veterinary practice ownership across the United States.

The end of 2025 saw several notable developments for the telehealth industry with early 2026 poised to potentially challenge the industry with the impending expiration of the short-term extension of the Medicare telehealth flexibilities. Below we highlight activity from late 2025 and provide an outlook for 2026.