Policy & Compliance
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July 14, 2025
UnitedHealth Settling Fraud Case Over Fake Invoice Scheme
UnitedHealth Group Inc. and a subsidiary are not going to trial in Colorado state court this week after the company reached a settlement with a defunct Colorado investment company that claimed UnitedHealth should have been liable for the "multi-million dollar fraudulent scheme" executed by a former employee, counsel for the plaintiff told Law360.
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July 14, 2025
Ga. County Wants 11th Circ. To Nix Trans Deputy's Health Win
A Georgia county urged the Eleventh Circuit to reverse a transgender sheriff's deputy's trial court win on claims that denying coverage for a vaginoplasty constituted discrimination in violation of Title VII, arguing the U.S. Supreme Court's recent decision upholding a Tennessee state ban on gender-affirming care for minors supported its appeal.
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July 14, 2025
Fla. Says High Court Rulings Back Trans Care Medicaid Ban
Florida told the Eleventh Circuit that recent U.S. Supreme Court rulings affirm the legality of a state law banning Medicaid payments for gender-affirming medical care, arguing its restrictions mirror a similar Tennessee law upheld by the justices because it centers on gender dysphoria diagnoses, not one's sex.
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July 14, 2025
Mich. Jury Sides With Red Cross In COVID Vax Refusal Suit
A Michigan federal jury on Monday found that a former American Red Cross nurse's request for an exemption from the organization's COVID-19 vaccine mandate wasn't based on a sincere religious belief that barred her from getting the injection, rejecting the worker's request for more than $6 million in damages for her firing.
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July 14, 2025
Masimo Corp. Settles Investor Suit Over Revenue Disclosures
Masimo Corp. has settled proposed class claims alleging the health technology firm misrepresented the company's finances and plans to investors, according to a filing in Southern California federal court.
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July 11, 2025
DOJ Sends Warning In Gender Care Provider Subpoenas
The announcement of federal subpoenas targeting doctors who offer gender-affirming care signals an escalation in the Trump administration's campaign against such treatment, experts say, delivering a warning to healthcare providers.
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July 11, 2025
AbbVie Defeats Investor Class Suit Alleging Humira Kickbacks
AbbVie on Thursday defeated a certified securities class action that accused it of giving healthcare providers unlawful kickbacks in exchange for prescribing its flagship arthritis drug Humira when an Illinois federal judge ruled that AbbVie provided legitimate services that were "integrally tied" to the drug itself.
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July 11, 2025
Hospital Says Wash. Withholding Docs In Billing Fraud Suit
A hospital system accused of overbilling Medicaid in connection to a neurosurgeon's fraud scheme contends the Washington state attorney general's office has wrongly refused to provide records from agencies involved in the misconduct investigation, according to new filings in federal court.
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July 11, 2025
Success Tricking FDA Shouldn't Protect Merck, Justices Told
Physicians asked the U.S. Supreme Court to review a decision immunizing Merck & Co. from antitrust claims over submissions it made to federal regulators over its mumps vaccine, arguing the Third Circuit went far beyond its peers in holding that deceiving the government isn't illegal if the deception worked.
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July 11, 2025
Fed. Circ. Questions Patent Ownership After J&J's $20M Loss
The Federal Circuit appeared somewhat skeptical Friday that an orthopedic surgeon held onto the rights of knee replacement patents that he disputably assigned elsewhere, which would endanger the $20 million infringement verdict he won against a Johnson & Johnson unit.
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July 11, 2025
Fired Red Cross Vax Refuser Seeks $6M As Jury Trial Wraps
An attorney for a nurse fired from the American Red Cross after being denied religious accommodation from the COVID-19 vaccine mandate asked a Detroit federal jury Friday for more than $6 million in damages for what he said was the organization's disregard of the woman's beliefs.
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July 11, 2025
$16M Deal Gets OK In Wage Suit Against Wash. Hospitals
A $16 million deal ending three consolidated suits accusing Providence Health & Services and two related entities of not giving nearly 23,900 meal and rest breaks can proceed, a Washington state judge ruled, finding the deal fair.
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July 11, 2025
Suppressing Rival Views Can Break Antitrust Laws, DOJ Says
The anti-vaccine group once tied to Secretary of Health and Human Services Robert F. Kennedy Jr. got a boost Friday in its D.C. federal court suit alleging that the Associated Press, The Washington Post, Reuters and the BBC colluded with social media platforms to censor rivals, drawing a Justice Department brief assailing news organization assertions that viewpoint competition can't be illegally suppressed.
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July 11, 2025
Powers Pyles Adds Ex-Feldesman Team In DC
Powers Pyles Sutter and Verville PC has strengthened its healthcare practice in Washington, D.C., with the creation of a sub-practice focused on health centers and staffed by five attorneys and a compliance expert who moved from Feldesman Leifer LLP.
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July 10, 2025
Penn Hospital Can't Escape Record $207M Med Mal Judgment
A Pennsylvania appeals court on Thursday affirmed a record $187 million verdict and subsequent $207 million judgment in a suit accusing the Hospital of the University of Pennsylvania of causing a newborn's catastrophic birth injuries, saying the award did not "shock the conscience" given the evidence presented at trial.
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July 10, 2025
HHS Narrows Health Benefits Available To Noncitizens
The U.S. Department of Health and Human Services on Thursday announced that immigrants living in the country without legal authorization and other noncitizens will no longer be eligible for benefits under Head Start and a host of other federal healthcare programs, based on the agency's reinterpretation of a 1996 social welfare law.
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July 10, 2025
Brookdale's $1.9M Deal Ends Investor Suit On Understaffing
An investor in retirement home operator Brookdale Senior Living Inc. has gotten a final nod for a deal settling her understaffing claims against the company's executives and directors in exchange for corporate reforms and fees and expenses totaling $1.9 million for her legal team.
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July 10, 2025
5 Employee Benefits Takeaways On The GOP Tax Bill
Congressional Republicans' sweeping tax and policy bill, which President Donald Trump sought and then signed, contains multiple provisions that caught the attention of employee benefits and executive compensation attorneys, including new changes to high-deductible health plans and an employer-side deduction limit affecting highly compensated employees. Here are five takeaways from employee benefits and executive compensation attorneys on what's in — and out of — the GOP megabill.
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July 09, 2025
Iowa Urges Judge Not To Block Law Regulating PBMs
The state of Iowa urged a federal judge Tuesday not to halt enforcement of state restrictions on pharmacy benefit managers that took effect earlier this month, arguing that most of the challenged law doesn't apply to the health plans and employers seeking to enjoin it.
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July 09, 2025
Mich. Justices Nix Ruling On ER Doctor-Hospital Agency
The Michigan Supreme Court on Wednesday reversed an appeals court's decision tossing a woman's vicarious liability claim against William Beaumont Hospital, finding she did not need to show she relied on a specific representation from the hospital to establish an ostensible agency relationship between the hospital and her treating doctor.
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July 09, 2025
Red Cross Vax Refuser Decries Firing Over Religious Beliefs
A former nurse for the American Red Cross suffered physically and economically after she was fired from the organization for not receiving the COVID-19 vaccine, counsel for the nurse told a Detroit federal jury Wednesday, arguing that, in the United States, the Red Cross should not be the arbiter of sincerely held religious beliefs.
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July 09, 2025
Sandoz, Buyers Defend $275M Deal Amid State Objections
Counsel for consumers, insurers and others urged a Pennsylvania federal court on Tuesday to approve Sandoz and its subsidiaries' $275 million deal settling claims it conspired with other companies to fix some generic drug prices, with Sandoz separately calling states' objections "a paternalistic desire to control private class action settlements."
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July 09, 2025
FDA Gets Early Win In Blue States' Abortion Pill Suit
A Washington federal judge has granted an early win to the federal government in a lawsuit from 17 Democratic attorneys general challenging the U.S. Food and Drug Administration's restrictions on access to the abortion drug mifepristone, finding the agency has properly reviewed the drug when issuing regulations.
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July 09, 2025
Mich. Judge Tosses Challenge To State Medicaid Abortion Ban
A Michigan judge has dismissed a challenge to the state's ban on Medicaid coverage for abortions, finding a nonprofit organization that offers financial assistance to women seeking abortions lacked standing.
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July 08, 2025
Insurer Fights ACA Loss, Citing Justices' Trans Care Ruling
Premera Blue Cross urged a Washington federal court to rethink an early win it granted against the insurer over its coverage policy for gender dysphoria surgery, arguing the U.S. Supreme Court's recent decision in U.S. v. Skrmetti is dispositive of a sex discrimination claim in the case.
Expert Analysis
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Plan Sponsors Must Prep For New Mental Health, Drug Rules
To comply with newly published health insurance rules requiring parity between access to mental health and substance use services compared to medical and surgical services, employers with self-insured plans will need to update third-party administrator agreements and collect data, among other compliance steps, say attorneys at Kilpatrick.
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A Primer On Navigating The Conrad 30 Immigration Program
As the Conrad 30 program opens its annual window to help place immigrant physicians in medically underserved areas, employers and physicians engaged in the process must carefully understand the program's nuanced requirements, say Andrew Desposito and Greg Berk at Sheppard Mullin.
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Class Actions At The Circuit Courts: September Lessons
In this month's review of class action appeals, Mitchell Engel at Shook Hardy identifies practice tips from four recent class certification rulings involving denial of Medicare reimbursements, automobile insurance disputes, veterans' rights and automobile defects.
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Proposed Legislation May Crack Down On Online Drug Ads
A bill recently proposed in Congress could serve as a sea change in how the U.S. Food and Drug Administration regulates drug-related speech, with significant trickle-down effects on various corners of not only the drug industry but also on consumers and providers themselves, say Dominick DiSabatino and Arushi Pandya at Sheppard Mullin.
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What To Expect From Calif. Bill Regulating PE In Healthcare
A California bill currently awaiting Gov. Gavin Newsom's approval, intended to increase oversight over private equity and hedge fund investments in healthcare, is emblematic of recent increased scrutiny of investments in the space, and may affect transactions and operations in California in a number of ways, say attorneys at Ropes & Gray.
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Vertex Suit Highlights Issues For Pharma Fertility Support
Vertex Pharmaceuticals' recent lawsuit challenging the U.S. Department of Health and Human Services' interpretation of the Anti-Kickback Statute is influenced by a number of reproductive rights and health equity issues that the Office of Inspector General should address more concretely, including in vitro fertilization and fertility preservation programs, says Mary Kohler at Kohler Health Law.
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CMS' New 'Breakthrough' Device Policy Shows Little Promise
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.
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A Preview Of AI Priorities Under The Next President
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.
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Managing Community Health Needs Assessments: A Checklist
Excerpt from Practical Guidance
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.
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Pa. Health Employers Must Prep For Noncompete Restrictions
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.
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FTC Focus: What Access To Patent Settlements Would Mean
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.
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Agencies Should Reward Corporate Cyber Victim Cooperation
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.
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Strategies To Defend Against Healthcare Nuclear Verdicts
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.