Policy & Compliance

  • October 01, 2024

    Novel FCA Decision Amplifies Voices Of Whistleblower Critics

    A Florida federal judge's characterization of whistleblowers as self-appointed "special prosecutors" when they file lawsuits on the federal government's behalf amplifies the voices of critics questioning the constitutionality of a key enforcement tool for fighting fraud, while threatening to create a circuit split.

  • October 01, 2024

    11th Circ. Hearsay Ruling May Open Door To Top Court Review

    An Eleventh Circuit decision to allow co-conspirator statements under a hearsay rule exclusion in a $400 million health insurance fraud case could stretch the scope of federal fraud law and might draw the attention of the U.S. Supreme Court.

  • October 01, 2024

    Biotech Investors Reach $32.5M Deal Over Failed COVID Test

    A class of Talis Biomedical Corp. investors accusing the company of inflating their stock price in the run-up to its IPO and then failing to launch a COVID-19 diagnostic test asked a California federal judge on Monday to preliminarily approve their $32.5 million settlement, citing Talis' shrinking cash reserves and imminent plans to file for bankruptcy.

  • October 01, 2024

    Gov't Looks To High Court To Preserve Free Preventive Care

    The federal government has taken a fight over the Affordable Care Act's requirements for cost-free preventive care to the U.S. Supreme Court.

  • October 01, 2024

    Doctors Were 'Bamboozled' By $160M Health Fraud, Jury Told

    A Houston man accused of defrauding the government out of $160 million by submitting false claims for diabetes medication is only guilty of creating a competitive business model, his attorney said Tuesday, telling a Texas federal jury it was "ridiculous" to say doctors across the country were "bamboozled" by an alleged scheme.

  • October 01, 2024

    FDA Chief Talks Shortages, Food Labels, Reorganization

    Pharmaceutical supply chain challenges. A major agency reorganization. Rare disease research. These issues were top of mind for U.S. Food and Drug Administration Commissioner Robert Califf in a recent "fireside chat" with the Alliance for a Stronger FDA, a group of trade associations, pharmaceutical companies, health-focused nonprofits and other stakeholders.

  • October 01, 2024

    Nostrum Labs Hits Ch. 11 A Year After Medicaid Settlement

    Nostrum Laboratories, a New Jersey drugmaker that paid millions to settle allegations that it underpaid Medicaid drug rebates for its bladder infection drug after it hiked the price more than 400%, filed for Chapter 11 protection with nearly $68.3 million in debt.

  • October 01, 2024

    'Unsworn' Actors Sink Qui Tam Provision, Fla. Judge Rules

    A Florida federal judge on Monday ruled that the provision of the False Claims Act allowing whistleblowers to bring suits on behalf of the federal government is unconstitutional, dismissing a closely watched Medicare Advantage fraud case and potentially upending a key federal enforcement tool.

  • September 30, 2024

    Calif. Sues Eureka Hospital For Denying Emergency Abortion

    California on Monday sued Providence of St. Joseph Hospital in Eureka for denying an emergency abortion to a woman it diagnosed with a serious pregnancy complication and sending her off to a small community hospital with a bucket and towels.

  • September 30, 2024

    Takeda End Payors, Direct Buyers Win Antitrust Class Cert.

    A New York federal judge Monday adopted a magistrate judge's recommendation to certify two classes of direct purchasers and end payors in consolidated antitrust actions accusing Takeda Pharmaceuticals Co. of unlawfully inflating the price of its diabetes treatment Actos by delaying entry of generic alternatives.

  • September 30, 2024

    Ga.'s 'Heartbeat' Abortion Ban Struck Down Once Again

    Georgia residents had their legal access to abortion temporarily restored Monday as the state's so-called heartbeat abortion ban was again struck down by a judge whose previous move to block the 2019 law had been reversed by the state's highest court.

  • September 30, 2024

    J&J Backs Off 340B Rebate Plan Following Feds' Objections

    Johnson & Johnson abandoned its plan Monday to offer rebates rather than upfront discounts for two medications under the 340B drug pricing law, contending it had no choice after a federal agency threatened to impose excessive penalties.

  • September 30, 2024

    Physician Assistant Seeks Lenient Term In $10M Fraud Case

    A North Carolina physician assistant is looking to spend just one year behind bars after a federal jury in Charlotte found him guilty of rubber-stamping bogus prescriptions for genetic testing, marking a far cry from prosecutors' requested nine-year prison sentence.

  • September 27, 2024

    Texas AG Wants Austin's Abortion Travel Fund Shut Down

    Texas Attorney General Ken Paxton on Friday accused the city of Austin of illegally using taxpayer funds to cover travel costs for people traveling out of the Lone Star State to get abortions, claiming that the city is misappropriating the funds in violation of the state constitution.

  • September 27, 2024

    Kappos' Bayh-Dole Warning To Clients Draws Debate

    An advocate for lowering drug prices squared off Friday against a former U.S. Patent and Trademark Office director about the potential risk of accepting government funds to develop drugs, as part of a discussion at New York University School of Law.

  • September 27, 2024

    Acadia To Pay $19.9M For Alleged Inpatient Billing Scheme

    Acadia Healthcare will pay $19.85 million to settle allegations it billed false claims to the federal government for medically unnecessary behavioral health services provided to patients who weren't even eligible for treatment, the U.S. Department of Justice announced.

  • September 27, 2024

    Why Many Drugs Remain Pricey 40 Years After Hatch-Waxman

    In the four decades since Congress passed the Hatch-Waxman Act in an effort to make generic drugs more available, the pharmaceutical industry has used patent thickets, "evergreening" and pay-for-delay tactics to block competition and keep prices of life-saving specialty drugs astronomical, several legal experts told Law360, while the industry argues other parties shoulder more of the blame.

  • September 27, 2024

    MetLife's 3rd Circ. Win Won't Stop ERISA Health Fee Suits

    The Third Circuit's recent decision upholding MetLife's escape from a lawsuit accusing the company of pocketing $65 million in pharmacy rebates instead of using the funds to lower employee healthcare costs hands additional authority over to employers facing a new wave of class action litigation over excessive health fees, attorneys say.

  • September 27, 2024

    Medical Equipment Co., Founder Settle FCA Suit For $20M

    A Florida-based medical equipment company and its founder will pay $20 million to settle claims under the federal False Claims Act that they improperly billed government healthcare plans for duplicated and unnecessary sales of devices meant to offer pain relief through electrical stimulation, Pennsylvania prosecutors said Friday.

  • September 26, 2024

    Virtua Discriminates Against Pregnant Patients, NJ Alleges

    Virtua Health discriminates against pregnant patients by forcing them to undergo drug testing for inpatient admission to its hospitals — a policy that does not apply universally to other patients, New Jersey Attorney General Matthew J. Platkin alleged in a lawsuit filed Thursday in New Jersey state court.

  • September 26, 2024

    Winner Of $8.6M Suit Wants Mich. Justices' Take On Cap

    The estate of a patient who won an $8.6 million medical malpractice verdict earlier this year is asking a Michigan federal court to certify a question to the state's Supreme Court to determine whether a statutory cap on noneconomic damages is constitutional.

  • September 26, 2024

    Senate Patent Bill Markups Delayed Until After Election

    Congressional hearings scheduled for Thursday to mark up several bills related to patents, including measures dealing with patent eligibility, validity challenges and drug patents, have been postponed until after Election Day due to the Senate's adjournment.

  • September 26, 2024

    NY Lawmakers Beat ADA Suit Over Contentious Mask Ban

    A New York federal judge threw out a challenge to Nassau County's ban on face masks worn by people trying to hide their identities in public, noting in an order Wednesday the plaintiffs lack standing since the ban doesn't apply to coverings worn to protect the wearer's health and safety.

  • September 26, 2024

    Healthcare Atty Rejoins Polsinelli After Foley Hoag Stint

    Polsinelli PC announced on Wednesday that a doctor and former healthcare policy attorney who spent 11 years during a previous stint with the firm has returned to its Washington, D.C., office as a public policy shareholder.

  • September 26, 2024

    Behavioral Health Exec Pleads Guilty To Medical Billing Fraud

    The chief executive of a behavioral health company on Thursday admitted to directing employees to bill Medicare and Medicaid for extra psychotherapy sessions that never took place.

Expert Analysis

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

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    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

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    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

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    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

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    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

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    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.

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    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

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    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

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    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

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    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

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    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.

  • Class Actions At The Circuit Courts: June Lessons

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    In this month's review of class action appeals, Mitchell Engel at Shook Hardy considers two recent decisions from the Third and Tenth Circuits, and identifies practice tips around class action settlements and standing in securities litigation.

  • How Congress Is Tackling The US Healthcare Shortage

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    With healthcare shortages continuing across the U.S. despite industry efforts to improve patient access to care, increased Medicare support for graduate medical education could be a crucial component of the solution, say Sarah Crossan and Miranda Franco at Holland & Knight.

  • The Current State Of Healthcare Transaction Reviews In Calif.

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    As of April, certain healthcare transactions in California have been subject to additional notification compliance requirements, and complying with these new rules could significantly delay and discourage some deals, says Andrew Demetriou at Husch Blackwell.