Policy & Compliance

  • December 18, 2024

    FTC Wants Express Scripts' Defamation Suit Tossed

    The Federal Trade Commission told a Missouri federal court that Express Scripts Inc. has no basis to challenge an interim agency report that only offered "qualified conclusions" from an ongoing study about how pharmacy benefit managers affect prescription drug prices.

  • December 18, 2024

    Senate Sends $895B Defense Bill To Biden's Desk

    The U.S. Senate on Wednesday easily passed an $895.2 billion defense policy and budget bill for 2025, despite criticism over a contentious clause effectively barring gender-affirming healthcare coverage for service members' transgender children.

  • December 18, 2024

    Top Conn. Cases Of 2024: Kickbacks, Paybacks And Bribes

    Judges and juries in Connecticut awarded several multimillion-dollar verdicts against companies big and small in 2024, socking Johnson & Johnson in a talc case in which the already substantial damages could multiply and ordering a pharmacy that paid kickbacks to cough up nearly four times the money it cost the state.

  • December 18, 2024

    Justices Will Decide If Medicaid Recipients Can Pick Providers

    The U.S. Supreme Court on Wednesday partially granted the state of South Carolina's petition to review a Fourth Circuit decision blocking its Medicaid program from ending its provider agreement with Planned Parenthood, agreeing to determine if the Medicaid Act allows a beneficiary to choose a specific provider. 

  • December 17, 2024

    NC Panel Revives Negligence Suit Against State Health Dept.

    An adult care center's constitutional claims accusing the North Carolina Department of Health and Human Services of negligently asserting bogus penalties and unfairly suspending admissions at the facility are timely, a North Carolina state appellate panel ruled Tuesday, reviving a case that previously landed before the North Carolina Supreme Court.

  • December 17, 2024

    3 Healthcare Decisions This Week You Don't Want To Miss

    The Third Circuit issued a precedential ruling allowing Pennsylvania to dip into the $300 million budget surplus of an insurance fund for doctors facing medical malpractice claims. Meanwhile in Texas, a split appellate panel found that a member of a national hospital chain can enforce an arbitration agreement with an employee. 

  • December 17, 2024

    Express Scripts, OptumRx Can't Ditch LA County Opioid Suit

    A California judge ruled Tuesday that Los Angeles County can keep pursuing a lawsuit claiming pharmacy benefit managers Express Scripts and OptumRx colluded with drugmakers to fuel the opioid epidemic, though the county must rework its complaint to specify how regulators were allegedly deceived.

  • December 17, 2024

    House GOP Asks CVS How Its PBM Treats Smaller Pharmacies

    Lawmakers on Capitol Hill are demanding documents from CVS on its pharmacy benefit manager's treatment of independent pharmacies, continuing to press the healthcare giant over potentially anticompetitive conduct.

  • December 17, 2024

    Feds Intervene In $200M FCA Case Against CVS

    The federal government has intervened in a whistleblower case accusing CVS and its subsidiaries of pocketing more than $200 million in overpayments, in order to defend the constitutionality of the False Claims Act's whistleblower provisions.

  • December 17, 2024

    5th Circ. Preserves Feds' ACA Trans Health Policy

    The Fifth Circuit upended a Texas court decision that invalidated a federal agency interpretation of the Affordable Care Act's provision on nondiscrimination in healthcare, keeping intact federal policy that prohibits insurers from discriminating against individuals seeking treatment for gender dysphoria.

  • December 17, 2024

    Nurse Survey Rule Case Sheds Light On Loper At 2nd Circ.

    A legal challenge over a federal rule saying registered nurses aren’t required at Medicaid compliance inspections is at the center of a Second Circuit case that promises to shed light on how courts could use the Loper Bright decision.

  • December 16, 2024

    Pa. Malpractice Fund Belongs To State, 3rd Circ. Rules

    The Third Circuit said Monday in a precedential ruling that Pennsylvania's medical malpractice insurance fund is an agency of the state and that it can dip into the fund's $300 million budget surplus.

  • December 16, 2024

    11th Circ. Appears Wary Of Doc's New Trial Bid In $27.5M Case

    The Eleventh Circuit on Monday questioned whether a Georgia doctor and his medical practice should get a new trial in a $27.5 million False Claims Act case on the basis that he and an expert who wasn't allowed to testify at trial believed the thousands of treatments he billed for were medically necessary and could be covered by Medicare, saying that contention seems to contradict the doctor's prior statements. 

  • December 13, 2024

    UnitedHealthcare Owes $900K For Services, Provider Says

    A national healthcare provider and two affiliated entities told a Minnesota federal court that UnitedHealthcare owes over $900,000 in independent dispute resolution awards entered against the carrier, accusing it of devising a scheme of denying, delaying and underpaying out-of-network providers.

  • December 13, 2024

    Texas AG Sues NY Doctor Over Telehealth Abortion Script

    Texas Attorney General Ken Paxton sued a New York doctor who founded the Abortion Coalition for Telemedicine in the Lone Star State Friday, accusing the physician of violating Texas state abortion laws by providing abortion-inducing prescription drugs to a Texas resident via telehealth.

  • December 13, 2024

    McKinsey To Pay $650M For Work With Opioid Maker Purdue

    Consulting giant McKinsey & Co. will pay $650 million to resolve charges related to its work helping Purdue Pharma market and boost sales of OxyContin, federal prosecutors announced Friday.

  • December 12, 2024

    3rd Circ. Backs Dismissal Of Anti-Abortion Group's Suit

    The Third Circuit on Thursday affirmed the dismissal of an anti-abortion pregnancy center's bid to block the enforcement of a subpoena seeking information about its donors, ruling its constitutional claims are not yet ripe.

  • December 12, 2024

    Wash. Justices OK Tax Break For Pharmacy Benefits Manager

    A Washington pharmacy benefits manager is exempt from a state business tax on its services for Medicaid patients because its corporate sibling paid premium taxes in connection with the same services, the state's high court affirmed Thursday.

  • December 12, 2024

    Lawmaker Sues Over Firing For Remarks On Jewish Rival

    Outgoing Connecticut State Rep. Anabel Figueroa, a Democrat representing Stamford, is suing her ex-employer Nuvance Health Inc. claiming it wrongly fired her over purportedly antisemitic comments she made in a radio interview about her successful primary challenger that she said were taken out of context.

  • December 11, 2024

    Montana Justices Uphold Temporary Block On Trans Care Ban

    Montana's highest court delivered a key victory for transgender youths and healthcare practitioners on Wednesday in a decision finding that privacy rights afforded by Montana's constitution favor a halt to the state's ban on gender-affirming care while litigation against it proceeds.

  • December 11, 2024

    Split 9th Circ. Nixes Trump-Era Hospital Reimbursement Rule

    A split Ninth Circuit on Wednesday struck down a U.S. Department of Health and Human Services policy that boosted the Medicare reimbursement rate for hospitals in lower-income communities, saying the agency's former secretary lacked authority to issue the policy despite his "laudable goal" of helping lower-wage hospitals.

  • December 11, 2024

    LA Fitness Fights To End DOJ's Gym Accessibility Suit

    LA Fitness urged a California federal judge to toss the U.S. Department of Justice's civil enforcement lawsuit alleging the gym chain failed to accommodate patrons with disabilities at its nearly 700 locations across the country, arguing the lawsuit relies on "isolated" incidents and doesn't show "a pattern and practice."

  • December 11, 2024

    Wisconsin Healthcare Co. Strikes Deal To End 401(k) Fee Suit

    A Wisconsin healthcare organization has agreed to settle a proposed class action alleging it allowed its 401(k) plan to pay exorbitant administrative fees and cost employees millions of dollars in retirement savings, according to a Wednesday federal court filing.

  • December 10, 2024

    Md. Jury Convicts Ex-Biotech Execs On Some Fraud Counts

    Two former biotech executives were convicted on some counts Monday following a monthlong Maryland federal court trial in a case alleging they juiced CytoDyn Inc.'s share price by lying to investors about the development of a drug to treat HIV and COVID-19.

  • December 10, 2024

    3rd Circ. Judge Unsure Subpoena Chills Anti-Abortion Donors

    A Third Circuit panel on Tuesday weighed whether an anti-abortion pregnancy center would suffer irreparable harm absent a court order blocking the enforcement of a subpoena seeking information about its donors, questioning whether donors would be imminently chilled if their names are disclosed to New Jersey investigators.

Expert Analysis

  • In The CFPB Playbook: Making Good On Bold Promises

    Author Photo

    The U.S. Supreme Court's decision upholding the Consumer Financial Protection Bureau's funding structure in the second quarter cleared the way for the bureau to resume a number of high-priority initiatives, and it appears poised to charge ahead in working toward its aggressive preelection agenda, say Andrew Arculin and Paula Vigo Marqués at Blank Rome.

  • Critical Questions Remain After High Court's Abortion Rulings

    Author Photo

    The U.S. Supreme Court's decisions in two major abortion-related cases this term largely preserve the status quo for now, but leave federal preemption, the Comstock Act and in vitro fertilization in limbo, say attorneys at Jenner & Block.

  • Navigating FDA Supply Rule Leeway For Small Dispensers

    Author Photo

    As the November compliance deadline for the U.S. Food and Drug Administration's new pharmaceutical distribution supply chain rules draws closer, small dispensers should understand the narrow flexibilities that are available, and the questions to consider before taking advantage of them, say attorneys at Faegre Drinker.

  • 1st Gender Care Ban Provides Context For High Court Case

    Author Photo

    The history of Arkansas' ban on gender-affirming medical care — the first such legislation in the U.S. — provides important insight into the far-reaching ramifications that the U.S. Supreme Court's decision in U.S. v. Skrmetti next term will have on transgender healthcare, says Tyler Saenz at Baker Donelson.

  • 6 Lessons From DOJ's 1st Controlled Drug Case In Telehealth

    Author Photo

    Following the U.S. Department of Justice’s first-ever criminal prosecution over telehealth-prescribed controlled substances in U.S. v. Ruthia He, healthcare providers should be mindful of the risks associated with restricting the physician-patient relationship when crafting new business models, says Jonathan Porter at Husch Blackwell.

  • After Chevron: Scale Tips Favor Away From HHS Agencies

    Author Photo

    The loss of Chevron deference may indirectly aid parties in challenging the U.S. Department of Health and Human Services' interpretations of regulations and could immediately influence several pending cases challenging HHS on technical questions and agency authority, say attorneys at Ropes & Gray.

  • After Chevron: FDA Regulations In The Crosshairs

    Author Photo

    The U.S. Supreme Court's overturning of the Chevron doctrine is likely to unleash an array of challenges against the U.S. Food and Drug Administration, focusing on areas of potential overreach such as the FDA's authority under the Federal Food, Drug and Cosmetic Act, say attorneys at Debevoise.

  • USPTO Disclaimer Rule Would Complicate Patent Prosecution

    Author Photo

    The U.S. Patent and Trademark Office's proposed changes to terminal disclaimer practice could lead to a patent owner being unable to enforce a valid patent simply because it is indirectly tied to a patent in which a single claim is found anticipated or obvious in view of the prior art, say attorneys at Sterne Kessler.

  • Navigating Scrutiny Of Friendly Professional Corps. In Calif.

    Author Photo

    In light of ongoing scrutiny and challenges to private equity participation in the California healthcare marketplace, particularly surrounding the use of the friendly professional corporation model, management services organizations should consider implementing four best practices, say attorneys at Holland & Knight.

  • Takeaways From New HHS Substance Use Disorder Info Rules

    Author Photo

    A new U.S. Department of Health and Human Services rule continues the agency's efforts to harmonize complex rules surrounding confidentiality provisions for substance use disorder patient records, though healthcare providers will need to remain mindful of different potentially applicable requirements and changes that their compliance structures may require, say attorneys at Ropes & Gray.

  • Calif. Banking Brief: All The Notable Legal Updates In Q2

    Author Photo

    The second quarter of 2024 in California, which saw efforts to expand consumer protection legislation and enforcement actions in areas of federal focus like medical debt and student loans, demonstrated that the state's role as a trendsetter in consumer financial protection will continue for the foreseeable future, say attorneys at Sheppard Mullin.

  • How Cannabis Rescheduling May Affect Current Operators

    Author Photo

    The U.S. Drug Enforcement Agency's proposal to reschedule marijuana to Schedule III provides relief in the form of federal policy from the stigma and burdens of Schedule I, but commercial cannabis operations will remain unchanged until the federal-state cannabis policy gap is remedied by Congress, say Meital Manzuri and Alexis Lazzeri at Manzuri Law.

  • Air Ambulance Ruling Severely Undermines No Surprises Act

    Author Photo

    A Texas federal court's recent decision in Guardian Flight v. Health Care Service — that the No Surprises Act lacks a judicial remedy when a health insurer refuses to pay the amount established through an independent review — likely throws a huge monkey wrench into the elaborate protections the NSA was enacted to provide, says Mark DeBofsky at DeBofsky Law.