Policy & Compliance
-
September 22, 2025
Mayo Clinic Can't Fully Nix Suit Over Withheld Benefits Info
The Mayo Clinic and its benefits administrator can't entirely escape a worker's suit claiming they pushed her to work with pricey out-of-network providers and wouldn't provide reimbursement estimates, after a Minnesota federal judge said she supported some federal benefits law claims with enough detail to remain in court.
-
September 19, 2025
Ga. Providers Seek Exit From 'Conspiratorial' BCBS Fraud Suit
Healthcare consulting firm HaloMD and several providers urged a federal judge Friday to toss a lawsuit from Blue Cross Blue Shield of Georgia accusing them of abusing a federal dispute resolution process for surprise medical bills, arguing the insurer's suit offers little more than "inflammatory, conspiratorial rhetoric."
-
September 19, 2025
CDC Panel Urges Caution On COVID Vax, Punts On Hep B
A panel of advisers at the Centers for Disease Control and Prevention on Friday voted unanimously to recommend that people receiving the COVID-19 vaccine this season do so only after discussing it with their health providers.
-
September 18, 2025
Brothers Blame Associate For $90M HIV Drug Fraud Scheme
Two Maryland brothers accused of selling $90 million worth of mislabeled HIV drugs told a Florida federal jury on Thursday that their charges stem from an associate hired for his pharmaceutical industry connections, but who instead lied about the medication's black market origins and told them it was purchased legitimately.
-
September 18, 2025
Mich. Top Court To Weigh Medicare's Role In No-Fault Cases
Michigan's highest court will weigh whether an injured driver who opted out of personal injury protection due to his Medicare coverage must offset his damages by billing the insurance program for accident-related medical expenses in a no-fault dispute.
-
September 18, 2025
HHS Shutters Miami Organ Donor Org. For 'Unsafe' Practices
Federal health officials have decertified a Miami-based organ procurement organization that arranges organ donations after an investigation found a pattern of "unsafe" practices, marking the first time the federal government has revoked the certification of such a group, according to an announcement Thursday from Health Secretary Robert F. Kennedy Jr.
-
September 18, 2025
Elevance Won't Cover Zepbound To Treat Apnea, Patient Says
Elevance Health, formerly known as Anthem Inc., arbitrarily excludes coverage of FDA-approved Zepbound to treat moderate to severe obstructive sleep apnea and refuses to consider requests for exceptions by maintaining that the medication is for weight loss, alleges a proposed class action filed by an enrollee in Indiana federal court Tuesday.
-
September 18, 2025
Senate Confirms Trump's Pick To Lead DOL Benefits Arm
The Senate confirmed fiduciary liability insurance expert Daniel Aronowitz on Thursday to lead the U.S. Department of Labor's employee benefits division, which oversees regulation and enforcement of employer-provided health and retirement plans.
-
September 18, 2025
Couple Slam NC Defense Attys In Hospital Negligence Appeal
A couple pursuing negligence claims against a local hospital scoffed at the idea that they were lurking on the sidelines waiting to cash in on a favorable outcome in a similar case, telling the North Carolina appeals court to ignore an amicus brief by defense attorneys arguing as much.
-
September 18, 2025
1st Circ. Won't Lift Block On HHS Job, Program Cuts
The First Circuit on Wednesday rejected a bid by the Trump administration to let it move ahead with cutting 10,000 jobs and end a number of programs at the U.S. Department of Health and Human Services while it appeals a Rhode Island federal judge's order temporarily barring the plan.
-
September 18, 2025
Withheld Email Not Enough To Revive Doc's Retaliation Suit
A psychiatrist failed to convince the Second Circuit to reinstate his suit claiming a New York City-area hospital system forced him out because he raised patient safety concerns, with the appeals court saying he couldn't show the hospital's omission of an email during discovery was purposeful.
-
September 17, 2025
J&J Whistleblowers Defend $1.6B False Claims Act Win
Whistleblowers filed a brief Wednesday in the Third Circuit in a closely watched False Claims Act appeal involving a $1.6 billion judgment against Johnson & Johnson unit Janssen as well as the constitutionality of the FCA's "qui tam" whistleblower provisions, arguing that the act's lawfulness has been settled by its "unbroken 162-year history."
-
September 17, 2025
FDA Says Vape Manufacturer Lying About Marketing Approval
The U.S. Food and Drug Administration on Tuesday sued manufacturers of flavored vapes in New Jersey federal court to seek an end to their sales, saying that they are falsely representing that their products had received marketing approval.
-
September 17, 2025
3rd Circ. Weighs Limits On NJ Medical Aid In Dying Act
The Third Circuit on Wednesday considered whether a Delaware woman with terminal cancer can challenge New Jersey's residency requirement for medical aid in dying, even though she has yet to be certified as having six months or less to live.
-
September 17, 2025
Hospital Agrees To End Retirement Plan Fee, Investment Suit
A New York hospital system told a federal court Wednesday it will end a proposed class action alleging it failed to remove underperforming investment options from its retirement plan and keep an eye on administrative costs, losing millions of dollars of employees' savings.
-
September 17, 2025
Ex-CDC Head Says RFK Jr. Urged Vax Schedule Rubber Stamp
Susan Monarez, the former head of the Centers for Disease Control and Prevention, told federal lawmakers on Wednesday she was abruptly fired just weeks into her tenure for "holding the line on scientific integrity."
-
September 16, 2025
Dr.'s COVID Falsehoods Are Free Speech, Wash. Panel Says
A Washington state appeals court unanimously ruled Tuesday that the Washington Medical Commission overstepped its authority by punishing a doctor for COVID-19 falsehoods he published to his blog, but affirmed the commission's decision to discipline him for prescribing ivermectin to COVID-19 patients.
-
September 16, 2025
Harborview Nurses In Ga. Score Collective Status In OT Suit
A pair of nurses who worked at Harborview Health Systems' facility in Rome, Georgia, brought enough evidence to show they and other similarly situated nurses were subjected to pay practices that shorted them on overtime wages to proceed as a collective action, a New York magistrate judge said Tuesday.
-
September 16, 2025
Merck Says Vaccine Case 'Poor Vehicle' For Antitrust Review
Merck & Co. told the U.S. Supreme Court to reject a bid from physicians looking to revive antitrust claims over submissions the pharmaceutical giant made to federal regulators concerning its mumps vaccine, arguing that the case is "an exceptionally poor vehicle" for review.
-
September 16, 2025
FTC Ends Director Overlap In Healthcare Space
The Federal Trade Commission said three members of Sevita Health's board of directors resigned after enforcers flagged an overlap with the board of a competing provider of specialty healthcare for people with intellectual and developmental disabilities.
-
September 16, 2025
Oregon Joins Expansion Of '5NP' Acupuncture Practice
Oregon has joined a number of states that have enacted laws that make it easier for people to get a "five needle" therapy with a raft of mental health benefits, including reduced substance withdrawal symptoms.
-
September 16, 2025
The Limits On Blue States' Push For Vaccine Policy Control
Democratic-run states are changing vaccine policies as HHS Secretary Robert F. Kennedy Jr. and other Trump health officials move to restrict vaccine access, creating a new policy patchwork. Those state efforts can only go so far, healthcare experts say.
-
September 16, 2025
Pharma Tests Drug Price Policies In Court: 3 Cases To Know
Two circuit courts issued notable rulings over the past week upholding laws aimed at lowering prescription drug prices. Elsewhere, insulin makers are seeking a panel rehearing in a proposed class action targeting discount programs. Here, Law360 Healthcare Authority looks at three key drug pricing cases you may have missed.
-
September 16, 2025
Wash. Justices Scrutinize Minimum Wage 'Live In' Exclusion
Washington Supreme Court justices on Tuesday pushed counsel for an adult family home on the stance that its "live in" workers are adequately protected by existing laws and regulations, pointing to testimony its employees are always on call and sometimes at risk of physical assault by residents.
-
September 16, 2025
Ill. Hospital Nonprofit Must Face Tobacco Fee Suit
An Illinois federal judge refused to toss the bulk of a proposed class action from an Illinois hospital worker who claimed a fee on the employee health plans of tobacco users was discriminatory and breached fiduciary duties under benefits law, finding most allegations sufficiently backed up to survive dismissal.
Expert Analysis
-
Whistleblowers Must Note 5 Key Differences Of DOJ Program
The U.S. Department of Justice’s recently unveiled whistleblower awards program diverges in key ways from similar programs at other agencies, and individuals must weigh these differences and look first to programs with stronger, proven protections before blowing the whistle, say Stephen Kohn and Geoff Schweller at Kohn Kohn.
-
The Licensure Landscape For Psychedelics Manufacturers
As the need for bulk manufacturing of psychedelic substances grows, organizations aiming to support clinical trials or become commercial suppliers must navigate a rigorous and multifaceted journey to obtaining a license from the U.S. Drug Enforcement Administration, say Kimberly Chew at Husch Blackwell and Jaime Dwight at Promega Corp.
-
OSHA Workplace Violence Citation Highlights Mitigation Steps
The Occupational Safety and Health Administration's recent citation against behavioral health company Circles of Care sheds light on the enforcement risks companies may face for failing to prevent workplace violence, and is a reminder of the concrete steps that can help improve workplace safety, say attorneys at Benesch.
-
When Banks Unknowingly Become HIPAA Biz Associates
There appears to be significant confusion regarding the application of the Health Insurance Portability and Accountability Act to financial institutions when serving healthcare-related clients, so these institutions should consider undertaking several steps as a starting point in the effort to achieve compliance, say attorneys at Vorys.
-
The Regulatory Headwinds Facing Lab-Developed Tests
Though the U.S. Food and Drug Administration's final rule regarding regulation of laboratory-developed tests outlines a four-year plan for ending enforcement discretion, and though this rule is currently being challenged in courts, manufacturers should heed compliance opportunities immediately as enforcement actions are already on the horizon, say attorneys at Kirkland & Ellis.
-
3 High Court Rulings May Shape Health Org. Litigation Tactics
Three separate decisions from the U.S. Supreme Court's most recent term — Loper Bright, Corner Post and Jarkesy — will likely strengthen healthcare organizations' ability to affirmatively sue executive agencies to challenge regulations governing operations and enforcement actions, say attorneys at McDermott.
-
A New Way Forward For COVID Vaccine Lawsuit Immunity
As Public Readiness and Emergency Preparedness Act protections for COVID-19 vaccines wane, adding those vaccines to coverage by the National Vaccine Injury Compensation Program would bolster defenses for administrators and manufacturers while also providing stronger remedies for those injured by vaccines, says Altom Maglio at MCT Law.
-
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.
-
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.
-
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.
-
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.
-
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.
-
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.