Policy & Compliance
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December 01, 2025
Hospitals Slam HHS' Move From Drug Discounts To Rebates
The American Hospital Association is leading litigation challenging the Trump administration's abrupt changes to a decades-old program governing the distribution of discounted prescriptions to low-income patients, telling a Maine federal court Monday that the government is unlawfully ignoring the costly impacts a rebate system will have on hospitals.
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December 01, 2025
1st Circ. Tosses Omni's Medicare Fraud Suit Over UTI Tests
A First Circuit panel declined to revive Omni Healthcare's False Claims Act suit accusing MD Labs of billing Medicare for unnecessary urinary tract infection tests, explaining in a published opinion Monday that Omni Healthcare's own staff ordered each test — sometimes even replacing doctors' orders for cheaper tests with the pricier ones.
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December 01, 2025
2nd Circ. Backs Anti-Abortion Groups' Free Speech Rights
New York Attorney General Letitia James can't sue faith-based groups promoting a so-called treatment to reverse medication-induced abortions, finding the groups are likely to succeed on the merits of their First Amendment challenge, the Second Circuit said Monday.
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December 01, 2025
J&J Narrows Ex-Employees' Prescription Benefits Suit
Johnson & Johnson narrowed a proposed class action claiming it unlawfully overcharged employees through a prescription drug benefits program, with a New Jersey federal judge ruling workers leading the suit failed to show how allegedly excessive fees the company paid to a benefits manager caused participants' costs to rise.
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December 01, 2025
Judge Upholds Mich. MedMal Cap, Cuts $8.5M Verdict
A Michigan federal judge has slashed the $8.5 million a jury awarded to the estate of a cancer patient suing over his doctor's treatment decisions to about $615,000, ruling that a state law limiting noneconomic damages in medical malpractice cases is constitutional.
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November 26, 2025
Up Next At High Court: ISP Liability & State Subpoena Suits
The U.S. Supreme Court will return Monday for the first week of its December oral argument session, during which the justices will consider whether internet service providers can be held liable for contributing to their customers' infringing activity online and whether the subjects of state subpoenas are required to first challenge them in state court.
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November 26, 2025
Nurse For App-Based Health Co. Can't Revive Retaliation Suit
A Washington appeals court refused to revive a nurse's suit claiming she was fired from an app-based medical provider for complaining that it underpaid and overworked independent contractors, ruling she failed to show her termination was because of her concerns rather than reports that she was unprofessional.
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November 25, 2025
UnitedHealth Gets OptumRx Antitrust Suit Sent To Arbitration
A group of independent pharmacies must arbitrate their proposed class claims that UnitedHealth-owned OptumRx gatekeeps its network of Medicare prescription patients by imposing unfair fees, a Washington federal judge said Tuesday, concluding the pharmacies haven't shown the arbitration clauses in question are unenforceable.
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November 25, 2025
Mich. Pharmacist Gets 46 Months For $4M Fraud Scheme
A former Michigan pharmacist who pled guilty to orchestrating a $4 million Medicare scam was sentenced by a federal judge to 46 months in prison and ordered to pay restitution and forfeit property as part of a plea deal, the U.S. Department of Justice announced.
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November 24, 2025
9th Circ. Clarifies FTC's Sanction Power In Backing $7M Win
The Ninth Circuit affirmed Monday a $7.3 million compensatory sanction and asset-freeze injunction against executives behind the "Success By Health" pyramid scheme, rejecting their argument, among others, that the justices' AMG v. FTC ruling requires the Federal Trade Commission to hold administrative proceedings before suing over rule violations.
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November 24, 2025
Teamsters Health Plan Wants Data Breach Suit Tossed
A Massachusetts federal judge should toss a proposed class action accusing a Teamsters healthcare plan of failing to protect plan participants' personal information, the plan argued, seeking dismissal of a suit that seeks to hold the plan liable for an August data breach.
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November 24, 2025
Mass. Judge Says States Can Fight Planned Parenthood Cuts
A Massachusetts federal judge on Monday chided a Trump administration lawyer for continuing to argue that a coalition of states lacks standing to seek to block what it says is the effective defunding of Planned Parenthood, even as it only just received a lengthy list of new requirements for Medicaid reimbursement.
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November 24, 2025
Mich. Christian Health Group Claims Right To Deny Trans Care
A Christian health system urged a federal court to permanently prohibit Michigan from enforcing a state civil rights law barring discrimination based on sexual orientation and gender identity, arguing the statute unconstitutionally hampers its ability to make faith-based hiring and policy decisions.
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November 24, 2025
Wash. Hits Regence BlueShield With Transparency Fine
Washington's insurance commissioner slapped Regence BlueShield with a $550,000 fine, the state announced Monday, for purportedly violating reporting requirements under a federal law that says health insurers must provide the same level of coverage for mental health care as general medical care.
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November 24, 2025
ND Justices Reverse Ruling That Struck Down Abortion Ban
North Dakota's near-total ban on abortion is back in effect after the state's top court narrowly reversed a lower court decision by failing to reach the supermajority required to declare the law unconstitutional.
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November 24, 2025
Hi-Tech Pharma CEO Beats Most Of Feds' Fraud Case
A Georgia federal jury acquitted Hi-Tech Pharmaceuticals' chief executive on the bulk of the conspiracy, fraud and money laundering charges leveled against him, rejecting allegations that he cheated his customers by drawing up bogus quality certificates.
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November 24, 2025
Justices Won't Review Doctor's Conviction For Reusing Devices
The U.S. Supreme Court on Monday rejected a petition from a North Carolina physician seeking to revisit the Fourth Circuit's decision to back her conviction for healthcare fraud.
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November 21, 2025
DC Judge Axes Teva Challenge To Drug Price Program
A D.C. federal judge tossed a challenge by Teva Pharmaceuticals to the Medicare drug price negotiation program, marking the latest in a series of losses by drugmakers and trade groups seeking to upend the program.
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November 21, 2025
Fla. Wound Doctor Agrees To Pay $45M For Overbilling Claims
A Florida doctor and his companies agreed to pay $45 million to settle a suit alleging he submitted fraudulent claims to Medicare for medically unnecessary wound care procedures, the U.S. government said Friday.
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November 21, 2025
Colo. Healthcare System Stiffing Workers, Court Told
A pair of former workers for a hospital and healthcare facility operator in Colorado have accused their past employer of routinely shortchanging their pay in violation of state and federal wage and hour laws, according to a proposed class action filed in federal court.
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November 21, 2025
PBMs Say Gov't Benefits From Drug Rebates FTC Condemns
Caremark Rx, Express Scripts and OptumRx have been given permission to seek documents they say will show the government benefits from the same type of prescription drug rebating activity that's being targeted by the Federal Trade Commission's insulin pricing case.
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November 21, 2025
'No Evidence' New Info Backs J&J Unit's Libel Suit, Court Told
A doctor being sued by Johnson & Johnson's bankrupt talc subsidiary pushed back on the unit's bid to revive its trade libel claim over a scientific article she wrote linking asbestos in talc to mesothelioma, arguing it failed to cite any evidence that undermines the court's finding that the article was a nonactionable statement of scientific opinion.
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November 21, 2025
Rothman Orthopaedics Hit With Pa. Wiretapping Lawsuit
Rothman Orthopaedics has been hit with a proposed class action in Pennsylvania alleging the company violated state wiretapping laws by intercepting private healthcare information on its website using a third-party tracking pixel.
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November 21, 2025
Hyperbaric Chamber Death Suit Not Covered, Insurers Say
Two Nationwide insurers said they have no duty to defend or indemnify a hyperbaric oxygen therapy center or its employees in a suit over the death of a 5-year-old boy, telling a Michigan federal court that there was no bodily injury or property damage caused by an occurrence, or accident.
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November 21, 2025
1st Circ. Clears IT Co. In Suit Over Zoll Patient Data Breach
An information technology company cannot be held liable for a data breach exposing the health information of patients of a unit of medical device maker Zoll Medical Corp, the First Circuit ruled, because the two companies did not have a business relationship permitting them to hold one responsible for another's conduct.
Expert Analysis
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What Trump Actions Mean For Federal Research Funding
New guidance from the National Institutes of Health represents a massive policy shift regarding federal funding for researchers at institutions of higher education, contributing to a perfect storm of significant resource shortfalls in upcoming years, say attorneys at Arnold & Porter.
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A Look At Healthcare Transaction Oversight In Oregon
Understanding Oregon's enforcement authority and its impact on proposed transactions last year provides a road map to the state's plans to strengthen its processes this year, though enforcement could be challenged by ongoing litigation, say attorneys at Ropes & Gray.
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Rethinking 'No Comment' For Clients Facing Public Crises
“No comment” is no longer a cost-free or even a viable public communications strategy for companies in crisis, and counsel must tailor their guidance based on a variety of competing factors to help clients emerge successfully, says Robert Bowers at Moore & Van Allen.
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High Court Must Acknowledge US History Of Anti-Trans Laws
Despite Justice Amy Coney Barrett's claim to the contrary during oral arguments in U.S. v. Skrmetti, U.S. governments at every level have systematically discriminated against transgender people, and the U.S. Supreme Court must consider this historical context in upcoming cases about transgender issues, says Paisley Currah at the City University of New York.
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The Fate Of Biden-Era Clinical Study Guidance Under Trump
Draft guidance about the study of sex and gender differences in medical product development issued by the outgoing Biden administration currently faces significant uncertainty and litigation potential due to the Trump administration's executive orders and other actions, say attorneys at Arnold & Porter.
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10 Issues To Watch In Aerospace And Defense Contracting
This year, in addition to evergreen developments driven by national security priorities, disruptive new technologies and competition with rival powers, federal contractors will see significant disruptions driven by the new administration’s efforts to reduce government spending, regulation and the size of the federal workforce, say attorneys at Thompson Hine.
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Dispelling 10 Myths About Health Provider-Based Compliance
Congress appears intent on requiring hospitals to submit provider-based attestations for all off-campus outpatient hospital locations, so now is the time for hospitals to prepare for this change by understanding common misconceptions about provider-based status and proactively correct noncompliance, say attorneys at McDermott.
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A Look At HHS' New Opinion On Patient Assistance Programs
A recent advisory opinion from the U.S. Department of Health and Human Services' Office of Inspector General follows a recent trend of blessing patient assistance program arrangements that implicate the Anti-Kickback Statute, as long as they are structured with appropriate safeguards to minimize the risk of fraud and abuse, say attorneys at Sheppard Mullin.
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2 Anti-Kickback Developments Hold Lessons For Biopharma
The U.S. Department of Justice's Anti-Kickback Statute settlement with QOL Medical and a favorable advisory opinion from the U.S. Department of Health and Human Services provide a study in contrasts, but there are tips for biopharma manufacturers trying to navigate the vast compliance space between them, says Mary Kohler at Kohler Health Law.
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Tips For Pharma-Biotech Overlap Reporting In New HSR Form
While there’s no secret recipe for reporting overlaps to the Federal Trade Commission in the new Hart-Scott-Rodino Act form, there are several layers of considerations for all pharma-biotech companies and counsel to reflect on internally before reporting on any deal, say attorneys at A&O Shearman.
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A Look At Drug Price Negotiation Program's Ongoing Impact
More than two years after the passage of the Inflation Reduction Act and the rapid implementation of the drug price negotiation program, attorneys at Ropes & Gray discuss how the IRA has influenced licensing strategies, and how maximum fair prices under the law have economically affected certain drugs.
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Preparing For A Possible End To The Subminimum Wage
The U.S. Department of Labor's proposed rule to end the subminimum wage for employees with disabilities may significantly affect the community-based rehabilitation and training programs that employ these workers, so certified programs should be especially vigilant about compliance during this period of evaluation and scrutiny, say attorneys at Jackson Lewis.
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Drug Pricing Policy Trends To Expect In 2025 And Beyond
Though 2025 may bring more of the same in the realm of drug pricing policy, business as usual entails a sustained, high level of legal and policy developments across at least six major areas, say attorneys at Ropes & Gray.