Policy & Compliance
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April 18, 2025
Mass General Inks $8.25M Deal To End Retirement Fee Suit
Boston-based healthcare system Mass General Brigham Inc. agreed to pay $8.25 million to settle a proposed class action alleging it unlawfully allowed its employee retirement plan to pay excessive administrative fees, according to a filing in Massachusetts federal court.
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April 17, 2025
Incyte Can Get Novartis' Privileged Info On Drug Royalty Deal
Novartis must produce certain privileged documents to Incyte concerning its understanding of their contract for royalty payments from sales of Incyte's blood cancer drug, unless Novartis agrees its former outside counsel, who negotiated the terms, won't testify about that topic at the upcoming contract breach trial, a New York federal judge said Thursday.
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April 17, 2025
RI Judge Wants To Know Who's Behind $11B Health Grant Cuts
A Rhode Island federal judge on Thursday pressed the Trump administration for details about the decision-makers behind the cancellation of billions in grants supporting state public health programs.
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April 17, 2025
Arkansas Bans PBMs From Owning Pharmacies
Pharmacy benefit managers operating in Arkansas will soon be prohibited from owning pharmacies in the state after Gov. Sarah Huckabee Sanders signed a bill that lawmakers say is meant to minimize conflicts of interest and safeguard patients.
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April 17, 2025
Tenet Asks Court To Enforce Dead Arbitrator's $546K Award
Tenet Healthcare Corp. has asked a Washington, D.C., federal judge to require the Service Employees International Union to follow an arbitrator's final order to pay $546,000 after making derogatory statements, despite the arbitrator dying before ruling on the union's post-judgment reconsideration motion.
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April 17, 2025
AFL-CIO, Unions Can Pursue Some DOGE Access Claims
The AFL-CIO, unions and advocacy groups may pursue allegations that Elon Musk's Department of Government Efficiency lacks the power to access data from the U.S. Department of Labor and other federal agencies, a D.C. federal judge ruled while tossing some claims under federal administrative and privacy law.
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April 17, 2025
3rd Circ. Questions Walmart's Duty To Disclose Opioid Probe
The Third Circuit on Thursday questioned the extent to which Walmart knew of the government's interest in prosecuting it for opioid sales, as it considered a bid by investors to revive class claims alleging the retail chain failed to disclose it was under investigation.
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April 16, 2025
Wyo. Justices Skeptical Of State Abortion Bans' Legality
The Wyoming Supreme Court on Wednesday seemed poised to side with a lower court judge that recent abortion bans violate the state's constitution, hinting that the Legislature doesn't have the authority to determine when life begins and thus cannot establish a compelling interest for the laws.
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April 16, 2025
UnitedHealthcare Owes $1M Medicare Shortfall, Hospital Says
UnitedHealthcare owes Connecticut's Danbury Hospital more than $1 million after bungling local Medicare Advantage cost calculations and refusing to correct its payment errors after the hospital provided notice of the problem, the healthcare facility alleged in a state court lawsuit.
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April 15, 2025
DC Asks Judge To Narrow Nursing Home Ruling
The District of Columbia urged a D.C. federal judge on Tuesday to narrow an injunction requiring it to do more to help disabled nursing home residents transition into the community, arguing the order reaches beyond the class of plaintiffs and is too vague.
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April 15, 2025
Food Service Co. Can't Escape Tobacco Surcharge Suit
A food service company can't dodge a proposed class action alleging it unlawfully charges tobacco users an additional fee to obtain health insurance, an Illinois federal judge ruled Tuesday, rejecting the company's assertion that federal benefits law doesn't require retroactive reimbursement for completing a cessation program.
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April 15, 2025
FDA Drug Rules Under Fire in Pharma Free Speech Fight
Vanda Pharmaceuticals says it spent years establishing that one of its flagship, FDA-approved products is an effective and safe treatment for jet lag. But after being denied agency approval for that use, the company launched a novel First Amendment challenge meant to dismantle federal rules for “off-label” drug promotion.
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April 15, 2025
39 AGs Urge Congress To Ban PBM Pharmacy Ownership
A bipartisan coalition of attorneys general have urged congressional leadership to pass legislation banning pharmacy benefit managers, their parent companies and affiliates from owning and operating pharmacies in order to boost competition and fairness.
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April 15, 2025
UBH Can't Nix Class Status In Coverage Guidelines Suit
United Behavioral Health can't unwind class certification in a lawsuit claiming it unlawfully imposed overly restrictive guidelines for coverage of residential mental health treatments, a California federal judge ruled, saying the group's parameters could be adjusted to meet a recent Ninth Circuit standard.
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April 15, 2025
Anthem Strikes Deal To End Mental Health Class Action
Anthem agreed to settle a class action from participants in employee health plans the insurer administered who alleged that coverage denials for inpatient mental health and substance use disorder treatments violated federal benefits and metal health parity laws, the parties told a New York federal court Tuesday.
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April 15, 2025
Minn. Couple Accused Of $15M Healthcare Fraud Scheme
A Minnesota couple whose company was hit with a default civil judgment last year now face an indictment alleging they carried out a $15 million scheme to defraud Medicare, Medicaid and insurance companies by overbilling for neurofeedback therapy and other medical services.
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April 15, 2025
Legislation Roundup: States Consider Slew Of Abortion Bills
Nearly three years after the U.S. Supreme Court's Dobbs decision upended federal abortion access protection, dozens of abortion-related bills are moving through state legislatures this year.
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April 15, 2025
Ga. Woman Says Baby 'Ripped Away' After Embryo Mix-Up
A South Carolina fertility clinic has been hit with a lawsuit from a former patient alleging that its doctors placed the wrong embryo inside her — a fact she discovered only when she, a white woman, gave birth to a Black boy — only to have the baby "ripped away from her" by his biological parents after months of raising him as her own.
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April 15, 2025
McGuireWoods Immune From Defamation Case, NC Panel Told
McGuireWoods LLP and a former partner have told a North Carolina state appeals court that they have absolute privilege over allegedly defamatory statements made in connection with an investigation into the former CEO of a managed care organization, arguing that the trial court should have granted them a pretrial win.
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April 15, 2025
Pa. Man To Plead Guilty In Harvard Body Parts Theft Case
A Pennsylvania man will plead guilty to a federal charge for transporting body parts that were allegedly stolen from cadavers by the manager of Harvard Medical School's morgue, according to a Tuesday filing.
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April 15, 2025
Medicare Advantage 'Upcoding' In Federal Crosshairs
Dr. Mehmet Oz and others have called for a crackdown on fraud and waste in privately run Medicare plans. But addressing "upcoding" won't be easy, and healthcare attorneys are watching to see whether the increased attention translates into actual enforcement.
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April 15, 2025
Abortion Bans At Wyo. High Court: 3 Things To Know
Wyoming’s highest court is set to hear arguments over whether two near-total abortion bans violate the state Constitution and its guarantee of personal choice in healthcare.
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April 14, 2025
9th Circ. Says $24M Punitive Damages In Jail Death Too Steep
A jury correctly determined that a healthcare contractor was liable for the death of a woman in custody in a Washington jail, a split Ninth Circuit panel ruled Monday, but its $24 million award for punitive damages was excessive.
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April 14, 2025
Ark. PBM Regulation Violates ERISA, Teamsters Fund Says
An Arkansas insurance regulation forcing health plans to turn over information about reimbursement rates negotiated by pharmacy benefit managers, or PBMs, conflicts with federal benefits law, a Teamsters healthcare fund claimed, urging an Illinois federal court to block the state from enforcing the rule.
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April 14, 2025
Judge Threatens Penalties Over Late Report In Fla. Fee Suit
A Florida federal judge threatened parties in a federal proposed class action over excessive fees charged to maintain retirement savings plans, warning there will be sanctions if they do not respond to an order to show why they failed to timely file a case management report.
Expert Analysis
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FDA's Data Monitoring Guidance Reveals Future Expectations
As the world of clinical research grows increasingly complex, the U.S. Food and Drug Administration's recent draft guidance on the use of data monitoring committees in clinical trials reveals how the agency expects such committees to develop, say Melissa Markey and Carolina Wirth at Hall Render.
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FDA Warning Indicates Scrutiny Of Regenerative Health Cos.
The U.S. Food and Drug Administration's recent warning letter to Akan Biosciences is a quintessential example of the agency's enforcement priorities for certain products involving human cells and tissues, and highlights ongoing scrutiny placed on manufacturers, say Dominick DiSabatino and Cortney Inman at Sheppard Mullin.
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2 Regulatory Approaches To Psychedelic Clinical Trials
Comparing the U.S. and Canada's regulatory frameworks for clinical trials of psychedelic drugs can be useful for designing trial protocols that meet both countries' requirements, which can in turn help diversify patient populations, bolster data robustness and expedite market access, say Kimberly Chew at Husch Blackwell and Sabrina Ramkellawan at AxialBridge.
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'Food As Health' Serves Up Fresh Legal Considerations
The growth of food as medicine presents a significant opportunity for healthcare organizations and nontraditional healthcare players to improve patient outcomes and reduce costs, though these innovative programs also bring compliance considerations that must be carefully navigated, say attorneys at McDermott.
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DC Circ. Ruling Heightens HHS Contract Pharmacy Challenges
The D.C. Circuit's recent ruling that the Section 340B program does not bar manufacturers from restricting deliveries of discounted drugs to contract pharmacies represents a second strike against the U.S. Department of Health and Human Services' current contract pharmacy policy and raises the stakes surrounding an upcoming Seventh Circuit ruling on the same issue, say attorneys at Foley Hoag.
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FTC Focus: Exploring The Meaning Of Orange Book Letters
The Federal Trade Commission recently announced an expansion of its campaign to promote competition by targeting pharmaceutical manufacturers' improper Orange Book patent listings, but there is a question of whether and how this helps generic entrants, say Colin Kass and David Munkittrick at Proskauer.
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3rd Circ.'s Geico Ruling May Encourage Healthcare Arbitration
The Third Circuit's recent decision in Geico v. Mount Prospect, finding that claims under New Jersey's Insurance Fraud Prevention Act can be arbitrated, strengthens arbitration as a viable alternative to litigation, even though it is not necessarily always a more favorable forum, say Khaled Klele and Jessica Osterlof at McCarter & English.
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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.