Policy & Compliance
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April 01, 2025
Tenn. PBM Statute Conflicts With ERISA, Judge Says
Tennessee law requiring pharmacy benefits managers to accept "any willing pharmacies" into their network clashes with the Employee Retirement Income Security Act, a federal judge ruled, saying the state can't enforce its statute against McKee Foods Corp. or other plans governed by the federal benefits law.
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April 01, 2025
Ex-Biotech CEO Wrongly Sentenced To 7 Years, DC Circ. Told
A former biotech executive who pled guilty to misleading investors about a blood-based COVID-19 test urged the D.C. Circuit to order a redo of his seven-year prison sentence on Tuesday, telling an appeals panel that the trial court miscalculated the sentencing guidelines.
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April 01, 2025
Top Court Abortion Case Sets High Stakes For Medicaid
The U.S. Supreme Court is set to hear arguments Wednesday in a case over South Carolina's attempt to exclude a Planned Parenthood chapter from Medicaid, weighing whether patients can take state officials to court over the Medicaid Act's "free choice of provider" provision. Experts say the outcome could have a broad impact on state authority to say which providers can or cannot treat low-income patients, and how.
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April 01, 2025
Medicaid Changes May Intensify State AG FCA Enforcement
After decades of increasing False Claims Act enforcement in the healthcare industry, relators and defense counsel alike are now bracing for even more activity by state attorneys general as a federal push to cut spending could leave state taxpayers bearing more Medicaid costs.
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April 01, 2025
23 States Sue HHS To Stop $11B In Health Grant Funding Cuts
Twenty-three states and the District of Columbia on Tuesday accused the Trump administration of illegally terminating about $11 billion in public health funding, causing layoffs and "chaos" in public health agencies across the country.
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March 31, 2025
Doc Loses Redo On Claims Hospital Lies Fueled Murder Case
A Michigan federal judge has dismissed a former Ohio physician's second attempt at suing the parent company of his ex-employer on allegations it fed prosecutors lies about his opioid prescribing practices that led to him being charged with 25 counts of murder, saying the lawsuit didn't fix the gaps left in the first case.
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March 31, 2025
Despite 'Admirable' Effort, Vertex Kickback Challenge Fails
A D.C. federal judge dealt a loss on Monday to gene therapy drugmaker Vertex Pharmaceuticals, ruling in favor of a U.S. Department of Health and Human Services advisory opinion that found the company's fertility preservation program could potentially violate the Anti-Kickback Statute.
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March 31, 2025
DocGo Can't Nix Investor Suit Over 'Indisputably False' Claims
A New York federal judge has trimmed a proposed class action alleging that mobile medical provider DocGo and its top brass misled stockholders before its $432 million migrant-services contract with New York City faced public scrutiny, but the judge found that claims stemming from the former CEO's "indisputably false" statements can proceed.
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March 31, 2025
Cuomo Defeats Suit Over NY Nursing Home COVID-19 Deaths
A New York federal judge threw out on Monday a proposed class action blaming former Gov. Andrew Cuomo and other Empire State officials for COVID-19 deaths in nursing homes, saying the claims are legally deficient and "the court's sympathy for plaintiffs and their loved ones simply cannot supplant governing law."
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March 29, 2025
Up Next At High Court: Terror Liability, Health Provider Choice
The U.S. Supreme Court will return to the bench this week to consider whether a federal law subjecting Palestinian government organizations to federal jurisdiction violates due process principles and if the Medicaid Act's provider choice provision allows individual benefit recipients to sue states over the disqualification of healthcare providers.
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March 28, 2025
Colo. Beats Amgen's Drug Price Cap Challenge, For Now
A Colorado federal judge Friday threw out Amgen's challenge to the Centennial State's drug price cap system, finding that Amgen is not subject to "direct regulation" under the law it's challenging and therefore doesn't have standing to sue.
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March 28, 2025
Janssen Owes Additional $1.5B In HIV Prescription Trial
A New Jersey federal judge on Friday added nearly $1.3 billion in penalties and $240 million in damages to a whistleblower False Claims Act verdict against Janssen over the off-label marketing of two HIV medicines, saying trial evidence laid out "a deliberate and calculated scheme."
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March 28, 2025
Plan Administrator Wins Electric Co.'s Union Healthcare Fight
An electric company can't use the Employee Retirement Income Security Act to claw back contributions to a union healthcare plan that weren't put toward benefits, a New York federal judge said Friday, tossing the company's suit against the plan's administrator.
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March 28, 2025
PE Firm Hits Back Against Medical Device Coating Challenge
Private equity firm GTCR BC Holdings LLC told a Federal Trade Commission in-house judge Friday the commission has a warped view of the medical device coatings market, as the firm fights a bid to block its $627 million acquisition of Surmodics Inc.
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March 28, 2025
Ex-Chicago Firefighter's Vaccine Bias Suit Fails, For Now
The city of Chicago dodged a former firefighter's lawsuit claiming he was fired for not complying with the city's COVID-19 vaccination policy after being given a religious exemption, with an Illinois federal judge ruling Friday he failed to show he was also exempt from the policy's testing requirement.
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March 28, 2025
Feds Settle NC Insurer's Medicare Reimbursement Suit
The U.S. Department of Health and Human Services has settled a North Carolina state-created insurance association's suit arguing it did not need to pay back the federal Medicare program for claims that should otherwise be covered by private insurance, and the parties jointly dismissed the matter Thursday.
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March 28, 2025
NC Biz Court Bulletin: TikTok Duel Heats Up, NIL Suit Plays On
In March, the North Carolina Business Court readied for trial in an insurance coverage dispute involving Smithfield Foods, heard why TikTok is subject to the state's jurisdiction, and allowed the Cardiac Pack's NIL suit against the NCAA to proceed while a parallel case plays out.
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March 27, 2025
Diopsys Inks $14M Deal Resolving Vision Testing FCA Claims
Medical device maker Diopsys Inc. has agreed to pay up to $14.25 million to put to rest allegations it violated the False Claims Act by submitting false Medicare and Medicaid claims for certain vision testing services, according to a U.S. Department of Justice announcement Thursday.
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March 27, 2025
DC Judge Seems Open To Fired Inspectors' Reinstatement Bid
A D.C. federal judge on Thursday questioned whether it would make practical sense to reinstate eight inspectors general fired by President Donald Trump while signaling openness to the federal watchdogs' argument that the president must follow the legally mandated process before they can be terminated.
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March 27, 2025
Fertility Co. Wants To Pull Device Maker Into Negligence Suit
A fertility products company wants two other companies to share potential liability from a Connecticut state lawsuit alleging that a recalled culture medium was responsible for the loss of embryos a couple were planning to use for in vitro fertilization.
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March 27, 2025
Feds Allowed To Weigh In On MultiPlan Pricing MDL
The federal government will be allowed to appear in multidistrict antitrust litigation targeting MultiPlan's out-of-network reimbursement rates to offer input on the legal framework for analyzing claims involving the joint use of algorithms, a practice it says poses "a growing threat" to free market competition.
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March 27, 2025
FCA Suit Alleging Unnecessary Spinal Surgeries Avoids Dismissal
A Washington federal judge declined Wednesday to toss the state and federal government's suit alleging a hospital operator made millions of dollars by submitting false claims to Medicaid and Medicare for medically unnecessary surgical procedures.
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March 27, 2025
Walgreens To Pay $2.8M For Alleged Medicaid Overcharges
Walgreens will pay $2.8 million under an agreement with federal prosecutors to settle allegations that it submitted inflated prices for some generic medications to Medicaid programs in Massachusetts and Georgia.
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March 27, 2025
DOJ's Antitrust Unit Targeting Anticompetitive Regulations
The U.S. Department of Justice launched a task force on Thursday aimed at eliminating state and federal laws and regulations that are hindering competition, with an initial focus on key sectors including housing, food and transportation.
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March 27, 2025
EMS Co. Accused Of Failing To Pay Proper Overtime
A private ambulance company has been hit with a proposed class action in Georgia federal court over allegations that it failed to pay workers overtime wages as required by the Fair Labor Standards Act.
Expert Analysis
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Proposed Cannabis Reschedule Sidesteps State Law Effects
The U.S. Department of Justice's recent proposal to move cannabis to Schedule III of the Controlled Substances Act provides certain benefits, but its failure to address how the rescheduling would interact with existing state cannabis laws disappointed industry participants hoping for clarity on this crucial question, says Ian Stewart at Wilson Elser.
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A Changing Regulatory Landscape For Weight Loss Drugs
As drugs originally approved to treat diabetes become increasingly popular for weight loss purposes, federal and state regulators and payors are increasing their focus on how these drugs are prescribed, and industry participants should pay close attention to rapidly evolving compliance requirements, say attorneys at Goodwin.
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Opioid Suits Offer Case Study In Abatement Expert Testimony
Settlements in the opioid multidistrict litigation provide useful insight into leveraging expert discovery on abatement in public nuisance cases, and would not have been successful without testimony on the costs necessary to lessen the harms of the opioid crisis, says David Burnett at DiCello Levitt.
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How HHS Discrimination Rule Affects Gender-Affirming Care
The U.S. Department of Health and Human Services' new final rule, which reinterprets the Affordable Care Act's anti-discrimination provision, greatly clarifies protections for gender-affirming care and will require compliance considerations from sponsors and administrators of most group health plans, say attorneys at McDermott.
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FTC Noncompete Rule's Impact On Healthcare Nonprofits
Healthcare entities that are nonprofit or tax-exempt and thus outside of the pending Federal Trade Commission noncompete rule's reach should evaluate a number of potential risk factors and impacts, starting by assessing their own status, say Ben Shook and Tania Archer at Moore & Van Allen.
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Key Takeaways From FDA Final Rule On Lab-Developed Tests
Michele Buenafe and Dennis Gucciardo at Morgan Lewis discuss potential consequences of the U.S. Food and Drug Administration's recently finalized rule regulating lab-developed tests as medical devices, and explain the rule's phaseout policy for enforcement discretion.
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Assessing HHS' Stance On Rare Disease Patient Assistance
The U.S. Department of Health and Human Services' recent advisory opinion, temporarily blessing manufacturer-supported copay funds for rare disease patients, carves a narrow path for single-donor funds, but charities and their donors may require additional assistance to navigate programs for such patients, says Mary Kohler at Kohler Health Law.
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Are Concessions In FDA's Lab-Developed Tests Rule Enough?
Although the U.S. Food and Drug Administration's new policy for laboratory-developed tests included major strategic concessions to help balance patient safety, access and diagnostic innovation, the new rule may well face significant legal challenges in court, say Dominick DiSabatino and Audrey Mercer at Sheppard Mullin.
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8 Questions To Ask Before Final CISA Breach Reporting Rule
The Cybersecurity and Infrastructure Security Agency’s recently proposed cyber incident reporting requirements for critical infrastructure entities represent the overall approach CISA will take in its final rule, so companies should be asking key compliance questions now and preparing for a more complicated reporting regime, say Arianna Evers and Shannon Mercer at WilmerHale.
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Mid-2024 FCA Enforcement And Litigation Trends To Watch
Reviewing notable False Claims Act trends and enforcement efforts in the last year and a half reveals that healthcare is a key enforcement priority for the U.S. Department of Justice, and the road ahead may bring clarification on Anti-Kickback Statute causation and willfulness standards, along with increased focus on private equity, cybersecurity and self-disclosure, say attorneys at Epstein Becker.
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Online Portal Helps Fortify Feds' Unfair Health Practices Fight
The Federal Trade Commission, U.S. Justice Department and the U.S. Department of Health and Human Services recently launched an online portal where the public can report potentially unfair healthcare practices, effectively maximizing enforcers' abilities to police anti-competitive actions that can drive up healthcare costs and chill innovation, say attorneys at Seyfarth.
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McKesson May Change How AKS-Based FCA Claims Are Pled
The Second Circuit’s analysis in U.S. v. McKesson, an Anti-Kickback Statute-based False Claims Act case, provides guidance for both relators and defendants parsing scienter-related allegations, say Li Yu at Dicello Levitt, Ellen London at London & Stout, and Erica Hitchings at Whistleblower Law.
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9th Circ. Ruling Puts Teeth Into Mental Health Parity Claims
In its recent finding that UnitedHealth applied an excessively strict review process for substance use disorder treatment claims, the Ninth Circuit provided guidance on how to plead a Mental Health Parity and Addiction Equity Act violation and took a step toward achieving mental health parity in healthcare, says Mark DeBofsky at DeBofsky Law.