Policy & Compliance

  • April 01, 2025

    Enforcement Delays Ahead Amid HHS Regional Closures

    The Trump administration's overhaul of the U.S. Department of Health and Human Services' in-house legal team is likely to slow enforcement proceedings and other compliance activities involving Medicare providers.

  • April 01, 2025

    Fla. Defends Sandoz Price-Fixing Settlement Terms

    Florida defended its deal with Sandoz Inc. on Monday, saying the other states suing the generic-drug maker over price-fixing have no right to object to the settlement, which does not require court approval and does not affect the states objecting to it.

  • April 01, 2025

    Tenn. PBM Statute Conflicts With ERISA, Judge Says

    Tennessee law requiring pharmacy benefits managers to accept "any willing pharmacies" into their network clashes with the Employee Retirement Income Security Act, a federal judge ruled, saying the state can't enforce its statute against McKee Foods Corp. or other plans governed by the federal benefits law.

  • April 01, 2025

    Ex-Biotech CEO Wrongly Sentenced To 7 Years, DC Circ. Told

    A former biotech executive who pled guilty to misleading investors about a blood-based COVID-19 test urged the D.C. Circuit to order a redo of his seven-year prison sentence on Tuesday, telling an appeals panel that the trial court miscalculated the sentencing guidelines.

  • April 01, 2025

    Top Court Abortion Case Sets High Stakes For Medicaid

    The U.S. Supreme Court is set to hear arguments Wednesday in a case over South Carolina's attempt to exclude a Planned Parenthood chapter from Medicaid, weighing whether patients can take state officials to court over the Medicaid Act's "free choice of provider" provision. Experts say the outcome could have a broad impact on state authority to say which providers can or cannot treat low-income patients, and how.

  • April 01, 2025

    Medicaid Changes May Intensify State AG FCA Enforcement

    After decades of increasing False Claims Act enforcement in the healthcare industry, relators and defense counsel alike are now bracing for even more activity by state attorneys general as a federal push to cut spending could leave state taxpayers bearing more Medicaid costs.

  • April 01, 2025

    23 States Sue HHS To Stop $11B In Health Grant Funding Cuts

    Twenty-three states and the District of Columbia on Tuesday accused the Trump administration of illegally terminating about $11 billion in public health funding, causing layoffs and "chaos" in public health agencies across the country.

  • March 31, 2025

    Doc Loses Redo On Claims Hospital Lies Fueled Murder Case

    A Michigan federal judge has dismissed a former Ohio physician's second attempt at suing the parent company of his ex-employer on allegations it fed prosecutors lies about his opioid prescribing practices that led to him being charged with 25 counts of murder, saying the lawsuit didn't fix the gaps left in the first case.

  • March 31, 2025

    Despite 'Admirable' Effort, Vertex Kickback Challenge Fails

    A D.C. federal judge dealt a loss on Monday to gene therapy drugmaker Vertex Pharmaceuticals, ruling in favor of a U.S. Department of Health and Human Services advisory opinion that found the company's fertility preservation program could potentially violate the Anti-Kickback Statute.

  • March 31, 2025

    DocGo Can't Nix Investor Suit Over 'Indisputably False' Claims

    A New York federal judge has trimmed a proposed class action alleging that mobile medical provider DocGo and its top brass misled stockholders before its $432 million migrant-services contract with New York City faced public scrutiny, but the judge found that claims stemming from the former CEO's "indisputably false" statements can proceed.

  • March 31, 2025

    Cuomo Defeats Suit Over NY Nursing Home COVID-19 Deaths

    A New York federal judge threw out on Monday a proposed class action blaming former Gov. Andrew Cuomo and other Empire State officials for COVID-19 deaths in nursing homes, saying the claims are legally deficient and "the court's sympathy for plaintiffs and their loved ones simply cannot supplant governing law."

  • March 29, 2025

    Up Next At High Court: Terror Liability, Health Provider Choice

    The U.S. Supreme Court will return to the bench this week to consider whether a federal law subjecting Palestinian government organizations to federal jurisdiction violates due process principles and if the Medicaid Act's provider choice provision allows individual benefit recipients to sue states over the disqualification of healthcare providers. 

  • March 28, 2025

    Colo. Beats Amgen's Drug Price Cap Challenge, For Now

    A Colorado federal judge Friday threw out Amgen's challenge to the Centennial State's drug price cap system, finding that Amgen is not subject to "direct regulation" under the law it's challenging and therefore doesn't have standing to sue.

  • March 28, 2025

    Janssen Owes Additional $1.5B In HIV Prescription Trial

    A New Jersey federal judge on Friday added nearly $1.3 billion in penalties and $240 million in damages to a whistleblower False Claims Act verdict against Janssen over the off-label marketing of two HIV medicines, saying trial evidence laid out "a deliberate and calculated scheme."

  • March 28, 2025

    Plan Administrator Wins Electric Co.'s Union Healthcare Fight

    An electric company can't use the Employee Retirement Income Security Act to claw back contributions to a union healthcare plan that weren't put toward benefits, a New York federal judge said Friday, tossing the company's suit against the plan's administrator.

  • March 28, 2025

    PE Firm Hits Back Against Medical Device Coating Challenge

    Private equity firm GTCR BC Holdings LLC told a Federal Trade Commission in-house judge Friday the commission has a warped view of the medical device coatings market, as the firm fights a bid to block its $627 million acquisition of Surmodics Inc.

  • March 28, 2025

    Ex-Chicago Firefighter's Vaccine Bias Suit Fails, For Now

    The city of Chicago dodged a former firefighter's lawsuit claiming he was fired for not complying with the city's COVID-19 vaccination policy after being given a religious exemption, with an Illinois federal judge ruling Friday he failed to show he was also exempt from the policy's testing requirement.

  • March 28, 2025

    Feds Settle NC Insurer's Medicare Reimbursement Suit

    The U.S. Department of Health and Human Services has settled a North Carolina state-created insurance association's suit arguing it did not need to pay back the federal Medicare program for claims that should otherwise be covered by private insurance, and the parties jointly dismissed the matter Thursday.

  • March 28, 2025

    NC Biz Court Bulletin: TikTok Duel Heats Up, NIL Suit Plays On

    In March, the North Carolina Business Court readied for trial in an insurance coverage dispute involving Smithfield Foods, heard why TikTok is subject to the state's jurisdiction, and allowed the Cardiac Pack's NIL suit against the NCAA to proceed while a parallel case plays out.

  • March 27, 2025

    Diopsys Inks $14M Deal Resolving Vision Testing FCA Claims

    Medical device maker Diopsys Inc. has agreed to pay up to $14.25 million to put to rest allegations it violated the False Claims Act by submitting false Medicare and Medicaid claims for certain vision testing services, according to a U.S. Department of Justice announcement Thursday.

  • March 27, 2025

    DC Judge Seems Open To Fired Inspectors' Reinstatement Bid

    A D.C. federal judge on Thursday questioned whether it would make practical sense to reinstate eight inspectors general fired by President Donald Trump while signaling openness to the federal watchdogs' argument that the president must follow the legally mandated process before they can be terminated.

  • March 27, 2025

    Fertility Co. Wants To Pull Device Maker Into Negligence Suit 

    A fertility products company wants two other companies to share potential liability from a Connecticut state lawsuit alleging that a recalled culture medium was responsible for the loss of embryos a couple were planning to use for in vitro fertilization.

  • March 27, 2025

    Feds Allowed To Weigh In On MultiPlan Pricing MDL

    The federal government will be allowed to appear in multidistrict antitrust litigation targeting MultiPlan's out-of-network reimbursement rates to offer input on the legal framework for analyzing claims involving the joint use of algorithms, a practice it says poses "a growing threat" to free market competition.

  • March 27, 2025

    FCA Suit Alleging Unnecessary Spinal Surgeries Avoids Dismissal

    A Washington federal judge declined Wednesday to toss the state and federal government's suit alleging a hospital operator made millions of dollars by submitting false claims to Medicaid and Medicare for medically unnecessary surgical procedures.

  • March 27, 2025

    Walgreens To Pay $2.8M For Alleged Medicaid Overcharges

    Walgreens will pay $2.8 million under an agreement with federal prosecutors to settle allegations that it submitted inflated prices for some generic medications to Medicaid programs in Massachusetts and Georgia.

Expert Analysis

  • NIST March-In Framework Is As Problematic As 2021 Proposal

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    While the National Institute of Standards and Technology's proposed march-in framework on when the government can seize patents has been regarded as a radical departure that will support lowering prescription drug costs, the language at the heart of it is identical to a failed 2021 notice of proposed rulemaking, says attorney Kelly Morron.

  • Spartan Arbitration Tactics Against Well-Funded Opponents

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    Like the ancient Spartans who held off a numerically superior Persian army at the Battle of Thermopylae, trial attorneys and clients faced with arbitration against an opponent with a bigger war chest can take a strategic approach to create a pass to victory, say Kostas Katsiris and Benjamin Argyle at Venable.

  • The Road Ahead For Florida's Drug Importation Program

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    Though the U.S. Food and Drug Administration approved Florida's drug importation program in January, a series of hurdles — including requisite buy-in from Canada — and potential legal challenges must be addressed before importation can begin, say attorneys at Ropes & Gray.

  • Assessing CDC's Revised Guideline On Opioid Prescriptions

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    Kenneth Weinstein, Nicholas Van Niel and Kate Uthe at Analysis Group look at newly available data to evaluate the impact that the Centers for Disease Control and Prevention's revised opioid monitoring guideline have had on prescription trends in recent years, highlighting both specific and overall decreases.

  • Valeant Ruling May Pave Way For Patent-Based FCA Suits

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    The Ninth Circuit’s recent ruling in Silbersher v. Valeant marks a significant development in False Claims Act jurisprudence, opens new avenues for litigation and potentially raises the stakes for patent applicants who intend to do business with the government, say Joshua Robbins and Rick Taché at Buchalter.

  • Suits Against Insulin Pricing Are Driven By Rebate Addiction

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    A growing wave of lawsuits filed by states, cities and counties against insulin manufacturers and pharmacy benefit managers improperly allocate the blame for rising insulin costs, when in actuality the plaintiffs are partially responsible, says Dan Leonard at Granite Capitol Consulting.

  • When Physician Retirement Arrangements May Be Legal

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    A recent advisory opinion from the Office of Inspector General regarding physician retirement arrangements sheds light on key considerations and mitigating factors that may be useful when attempting to balance healthcare operational needs with statutory conformity, says Magda Rodriguez at Day Pitney.

  • ESG Around The World: Gulf Cooperation Council

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    The Gulf Cooperation Council is in the early stages of ESG policy implementation, but recent commitments by both states and corporations — including increases in sustainable finance transactions, environmental commitments, female representation on boards and human rights enforcement — show continuing progress toward broader ESG goals, say attorneys at Cleary.

  • Navigating ACA Reporting Nuances As Deadlines Loom

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    Stephanie Lowe at Liebert Cassidy walks employers through need-to-know elements of Affordable Care Act reporting, including two quickly approaching deadlines, the updated affordability threshold, strategies for choosing an affordability safe harbor, and common coding pitfalls.

  • Lessons From Rare Post-Verdict Healthcare Fraud Acquittal

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    A Maryland federal court recently overturned a jury verdict that found a doctor guilty of healthcare fraud related to billing levels for COVID-19 tests, providing defense attorneys with potential strategies for obtaining acquittals in similar prosecutions, says attorney Andrew Feldman.

  • ChristianaCare Settlement Reveals FCA Pitfalls For Hospitals

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    ChristianaCare's False Claims Act settlement in December is the first one based on a hospital allegedly providing private physicians with free services in the form of hospital-employed clinicians and provides important compliance lessons as the government ramps up scrutiny of compensation arrangements, say attorneys at Sheppard Mullin.

  • Patent Waiver For COVID Meds Would Harm US Biopharma

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    If the Biden administration backs the World Trade Organization in waiving patent rights on COVID-19 treatments, it would negatively affect the U.S. biopharmaceutical industry and help foreign competitors, without necessarily expanding global access to COVID-19 care, says clinical pathologist Wolfgang Klietmann.

  • New CMS Rule Will Change Nursing Facility Disclosures

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    A new rule from the Centers for Medicare & Medicaid Services significantly expands disclosure requirements for nursing facilities backed by private equity companies or real estate investment trusts, likely foreshadowing increased oversight that could include more targeted audits, say Janice Davis and Christopher Ronne at Morgan Lewis.