Policy & Compliance
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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.
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November 20, 2025
Pharma Cos. Seek Early Win In States' Price-Fixing Lawsuit
A collection of states failed to prove an overarching conspiracy among 25 separate pharmaceutical companies to fix the prices of generic drugs, most of them dermatology formulations, the drugmakers argued Wednesday in support of a bid for an early win on one element of dozens of antitrust claims.
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November 20, 2025
5th Circ. Seeks Interpretation Of Miss. Health Decisions Law
A Fifth Circuit panel asked the Mississippi Supreme Court on Thursday to clarify an "ambiguous" state law that sets out which family members can act as surrogates and make healthcare decisions for relatives without the capacity to decide for themselves.
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November 20, 2025
Ala. County Must Face Inmate Death Claim, 11th Circ. Rules
An Eleventh Circuit panel ruled Thursday that no Alabama state law prevents a county from facing liability for an incarcerated person's death after substandard healthcare from a third-party medical provider the county hired.
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November 20, 2025
Blue Shield Of California, Magellan Sued Over 'Ghost Network'
Blue Shield of California and Magellan Health maintain a "ghost network" directory of mental health providers who don't exist or don't accept new patients, leading customers to hit a dead end or desperately resort to expensive out-of-network providers, according to a proposed class action filed Wednesday in California federal court.
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November 20, 2025
10th Circ. Weighs Colo. Law On Healthcare Sharing Plans
A Tenth Circuit panel grappled Thursday with how the court should interpret a Colorado law requiring entities not authorized to offer insurance in the state to report certain information about their healthcare sharing plans, in an appeal by a religious trade group challenging the law's constitutionality.
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November 20, 2025
Claims Firms Barred From Misleading Plaintiffs In Pharma MDL
On the same day that a Philadelphia federal judge approved $58 million in settlements as part of an ongoing generic-drug price-fixing multidistrict litigation, she also ordered several claims recovery firms to correct allegedly false and misleading ads used to attract potential clients seeking to make claims on the settlements.
Expert Analysis
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How New Fraud Enforcement Tool Affects Gov't Contractors
Government contractors will likely face greater scrutiny under the recently enacted Administrative False Claims Act, which broadens federal agencies' authority to pursue low-dollar fraud claims, but contractors may also find the act makes settlement of such claims easier to negotiate, say attorneys at Wiley.
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Consultants Should Be Aware Of DOJ's Potential New Reach
The U.S. Department of Justice's recent first-of-its-kind settlement with McKinsey & Co. indicates not only the DOJ's more aggressive stance toward businesses' potential criminal wrongdoings, but also the benefits of self-disclosure and cooperation when wrongdoing becomes apparent, says Dom Caamano at Kibler Fowler.
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Health Tech Regulatory Trends To Watch In 2025
With an upcoming change in administration and the release of some long-awaited rules, the healthcare industry should prepare for shifting trends, including a growing focus on health data and interest in technology-enabled delivery of healthcare, say attorneys at Orrick.
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10 Noteworthy CFPB Developments From 2024
In a banner year for consumer finance regulation, the Consumer Financial Protection Bureau made significant strides in its efforts to rein in Big Tech and nonbank financial firms, including via rules regarding open banking, credit card late fees, and buy now, pay later products, say attorneys at Wiley.
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The Future Of GLP-1 Policy After Drug Shortage Ends
If and when the U.S. Food and Drug Administration determines that GLP-1 RA drugs are no longer in short supply, regulators will face questions of how to balance access to GLP-1 RAs with statutory and policy considerations applicable to compounded drugs, say attorneys at Skadden.
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Top 10 Whistleblowing And Retaliation Events Of 2024
From a Florida federal court’s ruling that the False Claims Act’s qui tam provision is unconstitutional to a record-breaking number of whistleblower tips filed with the U.S. Commodity Futures Trading Commission, employers saw significant developments in the federal and state whistleblower landscapes this year, say attorneys at Proskauer.
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How White Collar Defense Attys Can Use Summary Witnesses
Few criminal defense attorneys have successfully utilized summary witnesses in the past, but several recent success stories show that it can be a worthwhile trial tactic to help juries understand the complex decision-making at issue, says Jonathan Porter at Husch Blackwell.
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Nutraceutical Patent Insights As Market Heats Up
Companies entering the expanding nutraceutical market and seeking patents to protect their innovations should evaluate successful nutraceutical claim language and common patent challenges in this field, say attorneys at Sterne Kessler.
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How White Collar Attys Can Use Mythic Archetypes At Trial
A careful reading of a classic screenwriting guide shows that fairy tales and white collar trials actually have a lot in common, and defense attorneys would do well to tell a hero’s journey at trial, relying on universal character archetypes to connect with the jury, says Jack Sharman at Lightfoot Franklin.
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What 2024 Election Means For Drugs, Medicare And Medicaid
With Republicans running the White House, U.S. House of Representatives and U.S. Senate, the incoming administration is likely to provide pathways — through new initiatives and others returning from Trump's previous presidency — for a range of potential changes to drug pricing, Medicare and Medicaid, say attorneys at Morgan Lewis.
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Justices Mull Sex-Based Classification In Trans Law Case
After the U.S. Supreme Court heard oral argument in U.S. v. Skrmetti this week, it appears that the fate of the Tennessee law at the center of the case — a law banning gender-affirming healthcare for transgender adolescents — will hinge on whether the majority read the statute as imposing a sex-based classification, says Alexandra Crandall at Dickinson Wright.
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Key Takeaways From FDA's Latest Social Media Warnings
The U.S. Food and Drug Administration's latest untitled letter concerning a drug company's social media promotion provides lessons for how companies should navigate risk presentation, FDA labeling requirements and superiority claims, say attorneys at Sheppard Mullin.
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Rank-And-File DOJ Attorneys Will Keep Calm And Carry On
Career prosecutors at the U.S. Department of Justice often pride themselves on their ability to remain apolitical in order to ensure consistency and keep the department’s mission afloat, and the incoming Trump administration is unlikely to upend this tradition, says Michael Landman at Bird Marella.