Policy & Compliance

  • October 29, 2024

    Beyond Abortion, 7 Ballot Questions Set To Shape Care

    While reproductive rights have led the healthcare debate this election season, voters across the country will shape state policies on a number of other hot issues, including a Medicaid work requirement and coverage for IVF. Law360 Healthcare Authority looks at seven ballot measures that go beyond abortion.

  • October 29, 2024

    Senate Panel Targets 'Clever' Pharma Pricing

    The Senate Judiciary Committee on Tuesday railed against drugmakers and pharmacy benefit managers for allegedly causing the high cost of prescription drugs, arguing that "Big Pharma" has used anticompetitive tactics through patenting to fleece American patients.

  • October 29, 2024

    HHS Hospital Pay Formula At High Court: 4 Things To Know

    With Americans focused on a presidential election unlike any in U.S. history, all's forgiven if you're not up on the latest healthcare case headed to the U.S. Supreme Court next week. Here's what you need to know about a dispute over a key federal payment formula used to compensate "safety net" hospitals.

  • October 29, 2024

    Latham Partner Brings Clerk Lessons To Hospital Pay Case

    When Latham & Watkins LLP partner Melissa Arbus Sherry steps in front of the U.S. Supreme Court for the 12th time, she plans to bring a lesson she learned from Justice John Paul Stevens about how to get past the legalese to the real ramifications of a case.

  • October 28, 2024

    Wash. AG Candidates Clash On Consumer Protection, Guns

    The candidates vying to replace Washington Attorney General Bob Ferguson, who carved out a national reputation as an antitrust champion, present starkly different visions on whether to build upon his tenure or reverse course, clashing not just on consumer protection, but also gun safety and access to reproductive care.

  • October 28, 2024

    SEC Sues To Enforce Subpoena On Telehealth Co.

    The U.S. Securities and Exchange Commission has asked a New York federal judge to order a weight loss-focused telehealth company to comply with a subpoena issued in connection with the SEC's investigation into whether the company violated federal securities laws.

  • October 28, 2024

    Ontrak Founder Can't Wipe Novel Insider Trading Verdict

    A California federal judge has upheld Ontrak founder Terren Peizer's first-of-its-kind insider trading conviction, holding that jurors had "more than enough evidence" to determine he based a $20 million share sale on nonpublic information that the health tech company was about to lose its biggest client.

  • October 28, 2024

    Ohio Hospital Defeats Religious Bias Suit Over COVID Vaccine

    An Ohio hospital defeated a former nurse's lawsuit claiming he was forced out after the medical center rejected his request for a religious exemption from its COVID-19 vaccination policy, with a federal judge finding he was never disciplined for failing to get the jab.

  • October 28, 2024

    HHS Says In-Home Evals Raised Insurers' Medicare Payments

    Private Medicare insurers collected an estimated $4.2 billion in extra federal payments last year from in-home health assessments they conducted, even though the evaluations led to no treatment, according to a report by the U.S. Department of Health and Human Services' internal watchdog.

  • October 25, 2024

    Tenn. Hospitals Want Former Execs Nixed From Kickback Row

    A hospital system on Friday urged a North Carolina federal court to dismiss whistleblower claims from former executives alleging the system excessively paid physicians to make referrals in order to receive Medicare and Medicaid money.

  • October 25, 2024

    Ga. Woman Gets 12 Years For $30M COVID Fraud Scheme

    A Georgia woman was sentenced to 12 years in prison Thursday for her role in filing more than 5,000 fraudulent COVID-19 unemployment insurance claims with the Georgia Department of Labor, which resulted in at least $30 million in stolen benefits.

  • October 25, 2024

    Pharmacy Must Pay $39.2M In Conn. Kickback Case

    A defunct compounding pharmacy must pay $39.2 million in damages and penalties for its role in a kickback scheme that made illegal payments to Connecticut state employees and retirees, a state court judge ruled Friday while letting the company's proprietor off the hook.

  • October 24, 2024

    11th Circ. Seeks Bias Test Briefing In Fla. Trans Patients' Suit

    The Eleventh Circuit has ordered Florida health officials and transgender individuals to provide additional briefing in the state's appeal to reverse a ruling blocking its ban on Medicaid coverage for gender-affirming care, directing the parties to present their positions on whether hostile discrimination analysis applies to certain classes of people.

  • October 24, 2024

    2nd Circ. Says Healthcare Arbitrations Were Properly Halted

    The Second Circuit affirmed Thursday that a lower court properly halted a group of healthcare providers from pursuing thousands of arbitrations against State Farm as part of an alleged massive fraudulent scheme, ruling in a novel opinion the injunction did not violate federal arbitration law.

  • October 24, 2024

    AMA Latest To Sue MultiPlan Over Out-of-Network Pricing

    The American Medical Association and the Illinois State Medical Society are the latest to accuse MultiPlan and the nation's largest health insurers of colluding through the use of the data firm's pricing tools to systematically underpay out-of-network providers, alleging in Illinois federal court Thursday that the "far-reaching and unlawful cartel" inhibits its members from offering critical care.

  • October 24, 2024

    Judges Doubt 'Troublesome' Comments Warrant New Trial

    Washington appellate judges appeared skeptical Thursday that a handful of comments could've triggered jury bias and tainted the trial of a Palestinian woman's medical malpractice case, though one judge called it "troublesome" that defense counsel told jurors the accused doctor was "from this part of the world."

  • October 24, 2024

    McDonald's Customers File First Suits Over E. Coli Outbreak

    A Colorado man and Nebraska woman have lodged the first lawsuits against McDonald's Corp. in the wake of the E. coli outbreak tied to its Quarter Pounder hamburgers, according to a pair of complaints filed in Illinois state court on Wednesday and Thursday.

  • October 24, 2024

    'Will Of The People' Upheld With Ohio Abortion Ban Quashed

    An Ohio state court judge on Thursday permanently blocked the state's "heartbeat law" that prohibited abortion around six weeks of pregnancy, citing a 2023 ballot measure that enshrined the right to an abortion in the state constitution.

  • October 24, 2024

    PBMs Want Separate FTC Hearings Over Insulin Prices

    Caremark Rx LLC, Express Scripts Inc. and OptumRx Inc. are calling for separate proceedings in the Federal Trade Commission's case accusing the pharmacy benefit managers of artificially inflating insulin prices through unfair rebate schemes.

  • October 24, 2024

    EEOC Reaches Deal With Rehab Center In Nurse's Bias Suit

    A rehabilitation and assisted living facility has reached a deal with the U.S. Equal Employment Opportunity Commission to end a disability discrimination lawsuit by a nurse with a sleep disorder who the agency said was unlawfully fired, according to a filing in Texas federal court.

  • October 24, 2024

    Logistics Cos. Don't Let Workers Avert Tobacco Fee, Suit Says

    Two Connecticut-based logistics companies unlawfully charge employees who use tobacco an extra fee for obtaining health insurance without offering full reimbursement if they complete a smoking cessation program, according to a proposed class action filed in federal court. 

  • October 24, 2024

    Dems Urge HHS To Better Protect Wheelchair Users From PE

    A pair of Democratic senators is pressing the U.S. Department of Health and Human Services to do more to protect the approximately 5.5 million wheelchair users in the country from private equity "abuses."

  • October 23, 2024

    3 Things To Know About Proposed OTC Contraception Regs

    The Biden administration's proposal to require private health insurers to pick up the cost of over-the-counter contraception could increase access for an estimated 52 million women. Here are three things to know about the newly proposed regulations.

  • October 23, 2024

    Wash. Health System Says HHS Let J&J 'Abuse' 340B Program

    A Washington safety net provider claims in a new suit that the federal government let Johnson & Johnson abuse the 340B drug discount program by allowing the manufacturer to pursue an "overbroad" and "intrusive" audit of the provider's drug purchases.

  • October 23, 2024

    5th Circ. Upholds Workers' Win In Health Co. Wage Suit

    A group of workers for an at-home healthcare company are employees, not independent contractors, a Fifth Circuit panel ruled, affirming a Louisiana federal court decision in three consolidated cases claiming the company cheated workers out of overtime.

Expert Analysis

  • CFPB's Medical Debt Proposal May Have Side Effects

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    The Consumer Financial Protection Bureau’s recent proposal to prevent medical debt information from appearing on consumer reports and creditors from basing lending decisions on such information may have initial benefits for some consumers, but there are potential negative consequences that should also be considered, say attorneys at Cooley.

  • 15 Areas That Would Change Under Health Data Rule Proposal

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    If finalized, the Office of the National Coordinator for Health Information Technology's proposed rule will significantly progress its efforts to advance interoperability, respond to stakeholder concerns and clarify compliance with the health IT certification program, say attorneys at Ropes & Gray.

  • 3 Healthcare FCA Deals Provide Self-Disclosure Takeaways

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    Several civil False Claims Act settlements of alleged healthcare fraud violations over the past year demonstrate that healthcare providers may benefit substantially from voluntarily disclosing potential misconduct to both the U.S. Department of Justice and the U.S. Department of Health and Human Services, say Brian Albritton and Raquel Ramirez Jefferson at Phelps Dunbar.

  • Takeaways From High Court's Tribal Health Admin Cost Ruling

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    The U.S. Supreme Court's recent determination that the government must reimburse two Native American tribes for administrative healthcare costs will help tribes maintain equal footing with the Indian Health Service when administering programs, and continues a pattern of how the current court aligns on tribal concerns, say attorneys at Lewis Roca.

  • FTC Focus: Private Equity Investments In Healthcare

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    As the Federal Trade Commission is tightening its scrutiny of private equity investment in healthcare, the agency is finding novel grounds to challenge key focus areas, including rollup acquisitions, the flip-and-strip approach and minority investments in rival providers, say attorneys at Proskauer.

  • High Court's Expert Ruling May Help Health Fraud Defendants

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    The U.S. Supreme Court's decision in Diaz v. U.S. appears to give the government a powerful new tool in calling its own agents as expert witnesses, but it could also benefit defense counsel in criminal healthcare fraud and other white collar criminal cases that arise in complex legal or regulatory environments, say attorneys at Holland & Knight.

  • Unpacking HHS' Opinion On Cell Therapy Refund Programs

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    A recent advisory opinion from the U.S. Department of Health and Human Services, determining that a biopharma company's refund program for its cell therapy will not be penalized, indicates an encouraging willingness to engage, but the regulator's assumptions about the program's limited term warrant a closer look, says Mary Kohler at Kohler Health.

  • DOJ Innovasis Settlement Offers Lessons On Self-Disclosure

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    The recent $12 million settlement with Innovasis and two of its executives demonstrates the U.S. Department of Justice's continued prioritization of Anti-Kickback Statute enforcement amid the growing circuit split over causation, and illustrates important nuances surrounding self-disclosure, say Denise Barnes and Scott Gallisdorfer at Bass Berry.

  • How Orange Book Antitrust Scrutiny Is Intensifying

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    Pharmaceutical patent holders should be reviewing Orange Book listing practices, as the Federal Trade Commission takes a more aggressive antitrust approach with actions such as the Teva listing probe, and the U.S. Food and Drug Administration calls attention to potentially improper listings, say attorneys at McDermott.

  • After Chevron: Slowing Down AI In Medical Research

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    The U.S. Supreme Court's recent decision overturning the Chevron doctrine may inhibit agencies' regulatory efforts, potentially slowing down the approval and implementation of artificial intelligence-driven methodologies in medical research, as well as regulators' responses to public health emergencies, say Ragini Acharya and Matthew Deutsch at Husch Blackwell.

  • FDA's Multifaceted Role On Display In MDMA Therapy Scrutiny

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    Ongoing deliberations at the U.S. Food and Drug Administration regarding MDMA-assisted therapy for post-traumatic stress disorder serves as a window into the intricate balance of scientific innovation and patient safety oversight, and offers crucial insights into regulatory nuances, say Kimberly Chew at Husch Blackwell and Kevin Lanzo at Pharmaka Clinical Consulting.

  • Analyzing FDA Draft Guidance On Clinical Trial Diversity

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    In light of the U.S. Food and Drug Administration's draft guidance on clinical trial diversity action plans, there are several important considerations for sponsors and clinical researchers to keep in mind to prevent delay in a drug or device application, say attorneys at Crowell & Moring.

  • In The CFPB Playbook: Making Good On Bold Promises

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    The U.S. Supreme Court's decision upholding the Consumer Financial Protection Bureau's funding structure in the second quarter cleared the way for the bureau to resume a number of high-priority initiatives, and it appears poised to charge ahead in working toward its aggressive preelection agenda, say Andrew Arculin and Paula Vigo Marqués at Blank Rome.