Policy & Compliance
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August 12, 2025
340B Rebate Plan Sparks Questions On Enforcement, Appeals
The drug industry, long critical of the 340B discount program, appeared to score a win when the Trump administration announced a post-sale rebate model. Hospitals and other buyers have some notes on a potentially deficient appeal process and other uncertainties.
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August 12, 2025
Religious Liberty Claims Spread In Abortion Ban Challenges
With the U.S. Supreme Court expanding religious protections, a groundswell of lawsuits challenging state abortion bans on free-exercise grounds has emerged.
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August 11, 2025
Aetna, CVS Want Lab's $21M Payment Suit Tossed For Good
Aetna and its parent company, CVS Health Corp., said a medical laboratory can't stand in the shoes of patients who were allegedly denied coverage by the insurer for lab tests, and they have asked a Connecticut federal judge to toss the lab's lawsuit for good.
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August 11, 2025
Rural Health Providers Say FCC Subsidy Rules Unclear
Rural healthcare providers still don't know what is and isn't covered by the Universal Service Fund and could use some clarification and guidance from the Federal Communications Commission, a group has told the agency.
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August 11, 2025
Proskauer Hires Epstein Becker Lawyer For DC, LA Practices
A healthcare litigator with experience in-house, at the U.S. government and in private practice, has joined Proskauer Rose LLP as a partner to continue working on healthcare, white collar defense and investigation, the firm announced Monday.
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August 08, 2025
Trump EO Requires Appointee Oversight Of US Grantmaking
President Donald Trump has issued an executive order requiring that all funding opportunity announcements and grant awards be reviewed by his political appointees and allowing for grants to be terminated that fall outside the administration's priorities.
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August 08, 2025
DC Medicaid Recipients Win Class Cert. For Notice Row
A D.C. federal judge granted a class certification motion lodged by a group of Medicaid beneficiaries who allege the district has violated their due process rights by failing to provide individualized written notices explaining prescription coverage denials and appeal rights.
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August 08, 2025
Administration Says States Can't Second-Guess ACA Changes
The Trump administration urged a Massachusetts federal court to reject a request by a group of states seeking to stay implementation of new rules that will reduce Affordable Care Act healthcare marketplace subsidies and enforce certain enrollment restrictions.
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August 08, 2025
Iowa PBM Law Challengers Seek Wider Block At 8th Circ.
Employers and benefit plans challenging an Iowa law aiming to limit pharmacy benefit managers' power to set drug prices will seek Eighth Circuit review of a district court judge's decision from July that temporarily blocked parts of the new policy as preempted by federal benefits law.
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August 08, 2025
Attys Seek Final OK Of $100M Walgreens Rx Cost Settlement
An Illinois federal judge should greenlight a $100 million settlement to claims that Walgreens overcharged insured customers for generic prescription drugs, the plaintiffs' attorneys said, asking the judge to wrap up the 8-year-old consumer protection litigation.
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August 07, 2025
Health Insurance Telemarketers Cough Up $145M In FTC Suits
Two telemarketing companies will pay $145 million to settle Federal Trade Commission claims that they misled millions of consumers into buying phony health insurance plans, the FTC said in a Thursday announcement accusing the telemarketers of making false promises that didn't provide what they offered.
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August 07, 2025
HHS Wins Another Round In Medicare Drug Negotiation Battle
A Texas federal court dealt another blow to the pharmaceutical industry Thursday when it ruled in favor of Medicare's Drug Price Negotiation Program, turning away arguments that the program is unconstitutional — the third such decision in two days.
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August 07, 2025
BioPharma Co.'s $15M Deal Over Ruined J&J Vaccines OK'd
A Maryland federal judge on Thursday granted final approval to a $15 million settlement to close out a stockholder derivative suit claiming Emergent BioSolutions Inc. and its top brass made a mint selling stock before their allegedly lax oversight led to the contamination of over 15 million Johnson & Johnson COVID-19 vaccine doses.
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August 07, 2025
Michigan AG Fights Bid To Pause PBM Price-Fixing Suit
Michigan's attorney general has said there is no reason to pause her price-fixing suit against pharmacy benefit managers Express Scripts and Prime Therapeutics for a pending dismissal motion, urging a federal judge not to put discovery on ice.
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August 07, 2025
10th Circ. Upholds Okla. Law Banning Trans Care For Minors
The Tenth Circuit declined to block an Oklahoma law banning gender-affirming care for transgender minors, ruling that a recent U.S. Supreme Court opinion backing a similar law from Tennessee undermines state residents' claims that the statute is discriminatory.
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August 07, 2025
2nd Circ. Axes Challenge To Medicare Drug Price Negotiations
In a published opinion Thursday, the Second Circuit turned away Boehringer Ingelheim's constitutional and administrative challenge to the Medicare Drug Price Negotiation Program, finding that the program is voluntary and it was lawfully implemented under the Inflation Reduction Act.
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August 07, 2025
Mich. Agency Can't Shake Suit Over Fights At Psych Hospital
The Michigan claims court has ruled that the state's health department must face a lawsuit over the beating of a child at a state-run psychiatric facility because the complaint adequately alleged hospital staff took intentional steps that "directly and predictably" led to the fight.
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August 06, 2025
6th Circ. Rips 'Stalking Horse' Ploy In Drug Negotiation Suit
The pharmaceutical industry will feel the sting of a Wednesday loss in a wide-ranging war over Medicare's power to negotiate drug prices, as the Sixth Circuit tossed a suit and accused one major company of utilizing a "stalking horse" to sue in a more favorable forum.
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August 06, 2025
States Urge Justices To Back Med Mal Laws In Federal Court
Tennessee and 26 other states on Wednesday urged the U.S. Supreme Court to hold that state statutes requiring an expert affidavit in all medical malpractice suits may be applied in federal court, arguing that overriding these laws under federal procedure rules would undermine state authority.
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August 06, 2025
Compelling ERISA Arbitration No Sure Thing, 9th Circ. Shows
The Ninth Circuit aligned with several other federal appeals courts when it recently struck down a clause in a food service company's employee health plan that barred class or representative actions, marking the latest in a series of setbacks for employers looking to push federal benefits suits into solo arbitration.
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August 06, 2025
Texas Hospital Should Face Retirement Plan Suit, Judge Says
A Houston hospital shouldn't dodge a proposed class action claiming it failed to remove a J.P. Morgan fund from its $2.8 billion employee retirement plan despite the investment option's consistent underperformance, a Texas federal magistrate judge recommended Wednesday, saying the allegations are solid enough to stay in court.
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August 06, 2025
Spinal Implant Co. CEO Avoids Prison After Plea Deal
The founder and CEO of Massachusetts medical device maker SpineFrontier was sentenced Wednesday to a year of supervised release, the first six months on home confinement, for directing employees to mislead the government about the nature of payments to a surgeon who was using the company's products.
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August 06, 2025
State AGs Want Final OK For $39M Apotex Price-Fixing Deal
Nearly every state attorney general in the country has asked a Connecticut federal judge to give final approval to a $39.1 million deal to settle claims that drugmaker Apotex Corp. schemed with others to fix prices and allocate markets for generic drugs, noting that the Florida-based company has already made the payment.
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August 05, 2025
Crowell Lands 16 Reed Smith Health Partners Across 4 Cities
Crowell & Moring LLP announced Wednesday that it is expanding its healthcare practice with dozens of attorneys from Reed Smith LLP, including 16 healthcare litigation partners based in Chicago, Los Angeles, San Francisco and Dallas, where the firm is launching a new shop with a former Reed Smith lawyer at the helm.
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August 05, 2025
Wash. Judge Questions Injunctions' Scope In Head Start Case
A Washington federal judge asked attorneys Tuesday to explain how the U.S. Supreme Court's decision concerning nationwide injunctions might impact efforts by a group of Head Start associations to halt federal directives restricting noncitizen access to the program and use of funds for diversity initiatives.
Expert Analysis
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Why DOJ's Whistleblower Program May Have Limited Impact
The U.S. Department of Justice’s new whistleblower pilot program aims to incentivize individuals to report corporate misconduct, but the program's effectiveness may be undercut by its differences from other federal agencies’ whistleblower programs and its interplay with other DOJ policies, say attorneys at Milbank.
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How Cos. With Chinese Suppliers Should Prep For Biotech Bill
A proposed bill to prohibit government-affiliated life sciences companies from contracting with Chinese biotech companies of concern may necessitate switching to other sources for research and supplies, meaning they should begin evaluating supply chains now due to the long lead times of drug development, say John O'Loughlin and Christina Carone at Weil Gotshal.
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FTC's Drug Middlemen Probe Highlights Ongoing Scrutiny
The Federal Trade Commission's interim staff report on its inquiry into pharmacy benefit managers suggests that the industry will remain under an enforcement microscope for the foreseeable future due to concerns about how PBMs affect drug costs and accessibility, say attorneys at Arnold & Porter.
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What Cos. Should Note In DOJ's New Whistleblower Pilot
After the U.S. Department of Justice unveiled a new whistleblower pilot program last week — continuing its efforts to incentivize individual reporting of misconduct — companies should review the eligibility criteria, update their compliance programs and consider the risks and benefits of making their own self-disclosures, say attorneys at Skadden.
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Motion To Transfer Venue Considerations For FCA Cases
Several recent decisions highlight the importance for practitioners of analyzing as early as possible whether a False Claims Act case warrants a change of venue, and understanding how courts weigh certain factors for defendants versus whistleblowers, say Ellen London at London & Stout, and Li Yu and Corey Lipton at DiCello Levitt.
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A Primer On EU's Updated Human Substance Regulations
The European Union's updated standards regarding quality and safety of substances of human origin meant for human application carry significant implications for companies that work with cells and tissues, and U.S. companies active in the EU market should pay particular attention to the import and export rules, say Geneviève Michaux and Georgios Symeonidis at King & Spalding.
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CFPB's Medical Debt Proposal May Have Side Effects
The Consumer Financial Protection Bureau’s recent proposal to prevent medical debt information from appearing on consumer reports and creditors from basing lending decisions on such information may have initial benefits for some consumers, but there are potential negative consequences that should also be considered, say attorneys at Cooley.
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15 Areas That Would Change Under Health Data Rule Proposal
If finalized, the Office of the National Coordinator for Health Information Technology's proposed rule will significantly progress its efforts to advance interoperability, respond to stakeholder concerns and clarify compliance with the health IT certification program, say attorneys at Ropes & Gray.
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3 Healthcare FCA Deals Provide Self-Disclosure Takeaways
Several civil False Claims Act settlements of alleged healthcare fraud violations over the past year demonstrate that healthcare providers may benefit substantially from voluntarily disclosing potential misconduct to both the U.S. Department of Justice and the U.S. Department of Health and Human Services, say Brian Albritton and Raquel Ramirez Jefferson at Phelps Dunbar.
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Takeaways From High Court's Tribal Health Admin Cost Ruling
The U.S. Supreme Court's recent determination that the government must reimburse two Native American tribes for administrative healthcare costs will help tribes maintain equal footing with the Indian Health Service when administering programs, and continues a pattern of how the current court aligns on tribal concerns, say attorneys at Lewis Roca.
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FTC Focus: Private Equity Investments In Healthcare
As the Federal Trade Commission is tightening its scrutiny of private equity investment in healthcare, the agency is finding novel grounds to challenge key focus areas, including rollup acquisitions, the flip-and-strip approach and minority investments in rival providers, say attorneys at Proskauer.
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High Court's Expert Ruling May Help Health Fraud Defendants
The U.S. Supreme Court's decision in Diaz v. U.S. appears to give the government a powerful new tool in calling its own agents as expert witnesses, but it could also benefit defense counsel in criminal healthcare fraud and other white collar criminal cases that arise in complex legal or regulatory environments, say attorneys at Holland & Knight.
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Unpacking HHS' Opinion On Cell Therapy Refund Programs
A recent advisory opinion from the U.S. Department of Health and Human Services, determining that a biopharma company's refund program for its cell therapy will not be penalized, indicates an encouraging willingness to engage, but the regulator's assumptions about the program's limited term warrant a closer look, says Mary Kohler at Kohler Health.