Policy & Compliance

  • February 10, 2025

    UnitedHealthcare Fined $3.4M In NC Over Billing Shortfalls

    UnitedHealthcare of North Carolina Inc. and its insurance affiliate got fined $3.4 million by the Tar Heel State's insurance regulator for failing to follow its own policies for negotiating with out-of-network providers to keep extra costs off of its policyholders.

  • February 10, 2025

    Mass. Judge Temporarily Blocks NIH Funding Cuts

    A Massachusetts federal judge issued a temporary hold Monday on a Trump administration plan to slash grant funding provided by the National Institutes of Health after 22 states sued to block the cuts.

  • February 10, 2025

    Trump Admin Violating Order To Unfreeze Funds, Judge Says

    A Rhode Island federal judge ruled Monday the Trump administration is not complying with the court's temporary restraining order barring a freeze on funding for federal grants and programs, ordering the administration to immediately restore the frozen funds.

  • February 07, 2025

    70 Depo-Provera Suits Joined In Florida's Northern District

    The U.S. Judicial Panel on Multidistrict Litigation on Friday consolidated more than 70 consumer lawsuits claiming that Pfizer Inc. failed to adequately warn patients and doctors about the risk of brain tumors associated with the hormonal contraceptive drug Depo-Provera in the Northern District of Florida.

  • February 07, 2025

    CFPB's Medical Debt Rule Halted For 90 Days By Texas Judge

    A Texas federal judge has issued a 90-day halt on an approaching effective day for a Consumer Financial Protection Bureau rule banning medical debt from credit reports, a day after the agency's new leadership said it needed time to consider the rule trade groups have sued to end.

  • February 07, 2025

    Trump Drops High Court Opposition To Transgender Care Ban

    The federal government on Friday changed course in a U.S. Supreme Court case challenging a Tennessee ban on transgender care for minors, telling the court that the Trump administration's position is that the statute does not deny equal protection on the basis of sex.

  • February 07, 2025

    Under The Radar: Bankruptcy News You May Have Missed

    A onetime financial adviser to UpHealth is opposing the debtor's Chapter 11 plan, Hearthside Food Solutions' official committee of unsecured creditors has balked at the company's executive bonus proposal in bankruptcy, and one-time investors in defunct real estate investment firm RealtyShares willingly dismissed a suit against the firm's former directors, litigation that had outlived the firm's Chapter 7 by more than a year.

  • February 07, 2025

    Chicago Hospital Network Inks $850K Retirement Suit Deal

    A Chicago-area hospital system will pay $850,000 to settle an ex-worker's proposed class action alleging it violated federal benefits law by failing to leverage the size of its $1.8 billion employee retirement plan to lower recordkeeping fees, according to filings Friday in Illinois federal court.

  • February 07, 2025

    Wash. AG Sues To Block 'Hateful' Trump Transgender Edict

    Washington, Minnesota and Oregon, along with three unnamed doctors, seek to block President Donald Trump's order targeting transgender youth and their medical providers, arguing in a complaint filed Friday in Seattle federal court that the Trump edict is unconstitutional, discriminates against transgender people and interferes with lifesaving healthcare.

  • February 06, 2025

    Doctors Org. Wants Health Agency Website Info Restored

    An advocacy organization representing physicians asked a Washington, D.C., federal judge Thursday to require federal agencies to restore public-health related web pages and data that were taken down after the Office of Personnel Management directed the agencies to root out references to "gender ideology" on their websites.

  • February 06, 2025

    6th Circ. Uncertain If Health Plan Administrator Is A Fiduciary

    A yacht-maker urged the Sixth Circuit on Thursday to revive its lawsuit accusing Blue Cross Blue Shield of Michigan of overpaying employee health plan claims so it could profit off of savings recovered later, but faced tough questions about whether plan administrator BCBSM was a fiduciary under federal benefits law.

  • February 06, 2025

    ERISA Preempts Banker's $5.5M Deferred Comp, Judge Rules

    The Employee Retirement Income Security Act preempts a former Leerink Partners employee's claims that she was cheated out of about $5.5 million in deferred compensation after the bank hired her under allegedly false pretenses from Goldman Sachs, a Massachusetts federal judge ruled Thursday.

  • February 06, 2025

    UnitedHealth Drops Bid To Toss Home Health Deal Challenge

    UnitedHealth Group and home health and hospice giant Amedisys Inc. dropped their bid to toss a case challenging their $3.3 billion merger after enforcers detailed the home health and hospice markets they allege will be hurt by the deal.

  • February 05, 2025

    Trump Signs Order Restricting Transgender Women In Sports

    President Donald Trump signed an executive order banning transgender women from competing in women's sports during a Wednesday afternoon press conference at the White House, continuing his trend of targeting transgender rights.

  • February 05, 2025

    Trade Groups Urge PBM Crackdown By Trump, Congress

    A coalition of industry trade groups sent letters Wednesday urging President Donald Trump and leaders in Congress to advance legislation reining in pharmacy benefit managers — which intermediate between drugmakers, insurers and pharmacies — in the next piece of federal government funding legislation.

  • February 05, 2025

    Penn Hospital Says $200M Judgment Imperils Local Care

    The Hospital of the University of Pennsylvania implored the Pennsylvania Superior Court on Wednesday to upend a purportedly historic $200 million medical malpractice judgment, arguing that the jury's award in the birth injury case was greater than the economic output of some nations and could seriously impact the hospital's operations.

  • February 05, 2025

    6th Circ. Urged To Revive Allergy Co.'s Antitrust Claims

    An allergy company tried Wednesday to persuade a noncommittal Sixth Circuit panel to revive an antitrust suit it brought against health insurance companies it says worked together to push it out of the market.

  • February 05, 2025

    Sheppard Mullin Adds Healthcare Reg Partner From Troutman

    Sheppard Mullin Richter & Hampton LLP on Wednesday announced the arrival of a healthcare partner joining from Troutman Pepper Locke LLP, continuing a streak of recent additions to its healthcare practice.

  • February 04, 2025

    9th Circ. Revives FCA Suit Over Military Meds Deliveries

    The Ninth Circuit on Tuesday revived a whistleblower lawsuit accusing Express Scripts Inc. of defrauding the U.S. Department of Defense out of billions of dollars in unnecessary medications for military personnel, saying the lawsuit wasn't barred by any public disclosures of the alleged fraud.

  • February 04, 2025

    Meet The Attys Taking On Merck In The Gardasil Trial

    An attorney at a personal injury firm with ties to Robert F. Kennedy Jr., President Donald Trump's pick for the nation's top healthcare position, is on the plaintiff team leading the first jury trial against Merck & Co. over claims the company wrongfully marketed its HPV vaccine Gardasil.

  • February 04, 2025

    Calif. AG Gets $25M To Fund Legal Fights Against Trump

    The California Legislature greenlighted a $25 million cash infusion Monday for the state attorney general's office in a strategic effort to bolster the state's legal defenses against President Donald Trump's policy agenda, including anticipated challenges to immigration and environmental regulations.

  • February 04, 2025

    Trump Trans Care Order Usurps Congress' Power, Suit Says

    The Trump administration overstepped when it issued an executive order cutting off gender-affirming care for people under 19, a group of transgender adolescents, young adults and their families told a Maryland federal court Tuesday, arguing the president is trying to usurp Congressional authority by forcing federally funded hospitals to discriminate.

  • February 04, 2025

    NY Exoneree Lands Rare 'Indifference' Win In Prison Doc Case

    Antonio Mallet spent nearly 20 years in a New York prison after he was convicted of a fatal shooting. After his release, he learned he had deadly prostate cancer that he claims was exacerbated by the "deliberate indifference" of prison doctors. A Second Circuit panel recently awarded him a rare appellate court victory.

  • February 04, 2025

    Docs, Lawmakers Cut Away At Prior Authorization Red Tape

    As physicians sounded the alarms, states have passed a patchwork of laws reining in prior authorization requirements. Health insurers say they're a necessary safeguard against unnecessary treatments and higher premiums. Healthcare professionals and legal experts argue more reforms are needed.

  • February 04, 2025

    4th Circ. Revives FCA Suit Alleging Faked Therapy Notes

    The Fourth Circuit on Monday sided with a whistleblower who accused her former employer of creating fake notes about addiction therapy sessions that never happened, finding that she had sufficiently detailed the allegations and connected the dots to defeat a motion to dismiss.

Expert Analysis

  • Breaking Down DOJ's Individual Self-Disclosure Pilot Program

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    The U.S. Department of Justice’s recently announced pilot program aims to incentivize individuals to voluntarily self-disclose corporate misconduct they were personally involved in, complementing a new whistleblower pilot program for individuals not involved in misconduct as well as the government's broader corporate enforcement approach, say attorneys at Paul Weiss.

  • FDA Warning Letter Tightens Reins On 'Research Only' Labels

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    A recent warning letter from the U.S. Food and Drug Administration to Agena Bioscience alleged the company’s diagnostic devices were labeled for research use only, but improperly promoted for human clinical purposes, signifying a reinforcement — and a potential narrowing — of the agency's policy on products labeled “research only,” say attorneys at Sheppard Mullin.

  • First 10b5-1 Insider Trading Case Raises Compliance Issues

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    The ongoing case against former Ontrak CEO Terren Peizer is the U.S. Department of Justice's first insider trading prosecution based primarily on the filing of 10b5-1 plans, and has important takeaways for attorneys reviewing corporate policies on the possession of material nonpublic information, say attorneys at Cadwalader.

  • Policy Misrepresentations Carry Insurance Rescission Risks

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    The Second Circuit's recent decision in Medical Mutual v. Gnik, finding that material misrepresentation in a clinic's insurance applications warranted policy rescission, is a clear example of the far-reaching effects that misrepresentations can have and provides a reminder that policyholders should employ relatively straightforward steps to decrease risks, say attorneys at Hunton.

  • The Pros And Cons Of NIST's Proposed March-In Framework

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    Recent comments for and against the National Institute of Standards and Technology’s proposed guidance on march-in rights — which permit the government to seize federally funded patents — highlight how the framework may promote competition, but could also pose a risk to contractors and universities, say Nick Lee and Paul Ragusa at Baker Botts.

  • 2 Recent Suits Show Resiliency Of Medicare Drug Price Law

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    Though pharmaceutical companies continue to file lawsuits challenging the Inflation Reduction Act, which enables the federal government to negotiate for lower prescription drug prices, recent decisions suggest that the reduced drug prices are likely here to stay, says Jose Vela Jr. at Clark Hill.

  • Defense Attys Must Prep For Imminent AI Crime Enforcement

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    Given recent statements by U.S. Department of Justice officials, white collar practitioners should expect to encounter artificial intelligence in federal criminal enforcement in the near term, even in pending cases, say Jarrod Schaeffer and Scott Glicksman at Abell Eskew.

  • Lessons For Nursing Facilities From DOJ Fraud Settlement

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    The U.S. Department of Justice's recent settlement with the owner of skilled nursing and assisted living facilities in Florida provides a cautionary tale of potential fraud risks, and lessons on how facilities can mitigate government enforcement actions, say Callan Stein and Rebecca Younker at Troutman Pepper.

  • HHS' Updated Tracking Tech Guidance Offers Little Clarity

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    The U.S. Department of Health and Human Services' Office for Civil Rights' updated guidance on the use of online tracking technologies appears more focused on legal issues raised in ongoing litigation with the American Hospital Association and less on practical guidance for covered entities, say attorneys at Sheppard Mullin.

  • Takeaways From The 2023 DOJ Fraud Section Report

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    Attorneys at Wiley discuss notable trends from the U.S. Department of Justice's recently reported Fraud Section activity last year and highlight areas of enforcement to watch for in the future, including healthcare fraud and Foreign Corrupt Practices Act violations.

  • 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.