• November 21, 2014

    CMS Floats 2016 Policies For ACA Marketplaces

    The Centers for Medicare & Medicaid Services on Friday published a sweeping proposed rule outlining how Affordable Care Act insurance plans will be regulated in 2016, floating major policies on renewals, rate review, network size and essential health benefits.

  • November 21, 2014

    Walgreen Says Unwanted Refill FCA Suit Lacks Evidence

    Walgreen Co. on Thursday urged a California federal court to toss a whistleblower’s suit accusing it of wrongly charging Medicare and Medicaid for unwanted prescription refills, saying he had not provided any evidence to back his allegations.

  • November 21, 2014

    IBRC Gets Thumbs-Up For Sale Of Blackrock Clinic Loans

    A Delaware bankruptcy judge gave Irish Bank Resolution Corp. the nod Friday to sell loans secured by equity in Ireland's Blackrock Clinic to a company owned by beef mogul Larry Goodman, rejecting opposition from a hospital shareholder and saying the evidence the sale was fair was “overwhelming.”

  • November 21, 2014

    DLA Piper Vets Create Health Policy Firm With Akin Gump

    Two former DLA Piper strategists have created a new consulting firm that will team up with Akin Gump Strauss Hauer & Feld LLP to advise clients on health policy issues, the strategists said Thursday.

  • November 21, 2014

    3rd Circ. Urged To Revive FCA Suit Over Wholesale Drug Costs

    The Third Circuit was urged during oral arguments on Friday to find that a purported whistleblower’s work to uncover an alleged scheme by Express Scripts Inc. and other companies to overbill the federal government for prescription drugs gave him grounds to sue under the False Claims Act.

  • November 21, 2014

    Health Care MVP: Gibson Dunn's Geoff Sigler

    Guiding health insurance giant Aetna Inc. to court victories over coverage disputes and helping the insurance industry block a Georgia law penalizing health plan administrators for not promptly paying claims has helped earn Gibson Dunn partner Geoff Sigler a spot on Law360's list of Health Care MVPs.

  • November 21, 2014

    GOP Hits Obama With Long-Awaited ACA Lawsuit

    The Republican-controlled U.S. House of Representatives on Friday filed a long-awaited lawsuit against the Obama administration challenging delay of the Affordable Care Act’s employer mandate and government payments to health insurance companies under the law.

  • November 20, 2014

    Tiversa Can't Attack Future Witness In LabMD Fight With FTC

    An administrative law judge on Wednesday shut down Tiversa Holding Corp.’s bid to discredit a former employee who is expected to poke holes in the Federal Trade Commission's data security assertions against LabMD Inc., saying it was improper for Tiversa to jump into the dispute.

  • November 20, 2014

    Prime Healthcare Can't Slip $50M Medicare Billing FCA Suit

    A California federal judge on Thursday rebuffed Prime Healthcare Services Inc.’s bid to dismiss a False Claims Act suit alleging the hospital group overcharged Medicare and Medicaid over $50 million by falsifying admissions information, accepting a government statement that the allegations weren’t public before the suit was filed.

  • November 20, 2014

    Wash. Fights In 9th Circ. To Revive Contraceptive Sale Rule

    Washington state officials Thursday urged the Ninth Circuit to overturn a lower court ruling that repealed regulations requiring pharmacists to carry emergency contraceptives like Plan B, saying the rule improves access to time-sensitive medicine and that there is no evidence the state has discriminated on the basis of religion.

  • November 20, 2014

    5 Convicted In $200M Medicare Con Ask 11th Circ. For Retrials

    Five defendants convicted of participating in a $200 million Medicare fraud scheme involving kickbacks for referrals of drug-addicted and vegetative patients argued before the Eleventh Circuit on Thursday that they should be granted new trials because they were not allowed a rebuttal witness at trial.

  • November 20, 2014

    Pa. High Court Won't Let State Close Health Centers

    The Pennsylvania Supreme Court on Thursday granted a Service Employees International Union affiliate’s bid for a preliminary injunction stopping the state from closing 26 community health centers, saying it was necessary to prevent immediate and irreparable harm.

  • November 20, 2014

    HHS Admits ACA Enrollment Stats Inflated By 400K

    The U.S. Department of Health and Human Services said Thursday that it accidentally overstated Affordable Care Act sign-ups by almost 400,000 policies, compounding the Obama admnistration's recent troubles on transparency and prompting Republicans to question whether regulators intentionally inflated the enrollment figures.

  • November 20, 2014

    Health Care MVP: King & Spalding's Michael Paulhus

    King & Spalding LLP's Michael Paulhus has set himself apart in the False Claims Act space over last year by securing several key wins for clients like Omnicare Inc. that set precedent for future whistleblower cases, earning him a spot as one of Law360's Health Care MVPs.

  • November 20, 2014

    Atty Must Face Ex-Client's Claim He Botched Surgery Suit

    A New York federal court refused to toss legal malpractice claims against a New York attorney over his alleged mishandling of a medical malpractice suit in which his disfigured client was left without legal recourse against her doctor, a Thursday court filing revealed.

  • November 20, 2014

    Deals Rumor Mill: Fresenius, Springleaf, Bain Capital

    Fresenius Medical Care Holdings Inc. and Permira have teamed up to bid for The Groupe Danone's $6 billion medical nutrition business, while Springleaf Holdings Inc. and Centerbridge Partners LP are among a host of players interested in buying a Citigroup Inc. lending unit that could be worth more than $4 billion.

  • November 20, 2014

    United Healthcare Dodges Chiropractor's TCPA Suit

    UnitedHealthcare Inc. on Wednesday ducked a proposed class action brought by a chiropractor alleging violations of the Telephone Consumer Protection Act after an Illinois federal judge said that the chiropractor’s provider agreement stipulated that his complaint had to be arbitrated.

  • November 20, 2014

    $6B Record Haul For DOJ As FCA Reaches New Heights

    The U.S. Department of Justice on Thursday announced that it recovered $5.7 billion through False Claims Act litigation in fiscal 2014, a record haul buoyed by exceptionally large penalties against financial institutions as well as continued success policing hospitals, drugmakers and defense contractors.

  • November 19, 2014

    Walgreen Settles With Rival Over Poached Employees

    Walgreen Co. has resolved its lawsuit against Pharmacy Solutions Inc. over the rival pharmacy's decision to hire away managers from an Idaho business specializing in home infusion therapy that Walgreen acquired months before, according to an order issued Wednesday.

  • November 19, 2014

    Doctor Deal Not Anti-Competitive, St. Luke's Tells 9th Circ.

    St. Luke’s Health System Ltd. on Wednesday urged the Ninth Circuit to rule that its $16 million acquisition of an independent physician practice does not violate federal antitrust law, arguing that a lower court ignored the deal’s benefits, including the ability to meet Affordable Care Act requirements.

Expert Analysis

  • Differentiate Your Litigation Practice With Data Security

    Jennifer Topper

    Despite the significant tilt toward technology in how litigation is now conducted, many senior lawyers still delegate tech-related issues to e-discovery specialists or associates at their firms. This is a missed opportunity not just for client development, but also for shaping the way the firm and lawyer are seen in the eyes of corporate counsel, says legal industry business development specialist Jenn Topper.

  • Novartis FCA Case Reaffirms Importance Of Company Policies

    Michael Loucks

    To the extent other courts adopt the New York federal court's analysis in U.S. v. Novartis Pharmaceuticals Corporation, the collateral consequence of an employee breach of internal policy or industry code of ethics and a corporate failure to appropriately sanction those employees could yield adverse consequences in the event of follow-on federal False Claims Act litigation, say attorneys with Skadden Arps Slate Meagher & Flom LLP.

  • The Print Room: How To Spend Less And Get More

    Senthil Rajakrishnan

    Our estimates indicate that some law firms spend up to $8,000 per attorney each year on print-related costs. Although we live in a digital world, hard copy printing will remain an important part of business for years to come. Changing technology, however, offers opportunities to improve efficiencies and save money, say Senthil Rajakrishnan and Ryan Mittman of HBR Consulting LLC.

  • Don't Be Shocked By NY's 'Surprise Bills' Law

    Jackie Selby

    New York's recently enacted Emergency Medical Services and Surprise Bills law will impact billing and reimbursement for some out-of-network health care services, require new disclosures from providers regarding their health plan participation status and add new rules for health plans regarding networks and reimbursement for out-of-network services, says Jackie Selby of Epstein Becker & Green PC.

  • Dewey Partner Clawback Ruling May Hurt New York Law Firms

    Evan C. Hollander

    Unless the recent ruling in the Dewey & LeBoeuf LLP bankruptcy case is overturned on appeal or the New York Legislature amends the state’s fraudulent transfer and partnership laws, partners of New York firms will bear greater risk if their firms fail than will members of many non-New York partnerships. This risk factor might even affect decisions by prospective lateral partners about which firms to join, say attorneys with Arnold & Porter LLP.

  • Containing Bad Actor Damage From Innocent Co-Insureds

    Kevin B. Dreher

    Evanston Insurance Company v. Agape Senior Primary Care illustrates the potentially inequitable effect of policy rescission innocent co-insureds suffer far too often when their coverage is not protected by law or contract from the misdeeds of an individual bad actor, say Kevin Dreher and Natalie Metropulos of Reed Smith LLP.

  • FCA Case Will Likely Set Standard On ACA Overpayments

    Bill Mateja

    A New York federal court's ruling on the motion to dismiss that was just filed in the False Claims Act suit against Continuum Health Partners Inc. will most likely set forth some needed guidance as to what kind of factual scenario triggers the start date for the Affordable Care Act’s 60-day overpayment rule, say Bill Mateja and Mike Nammar of Fish & Richardson PC.

  • CMS Meaningful Use Rules Are Off To A Meandering Start

    Julia R. Hesse

    Missteps and delays from The Center for Medicare & Medicaid Services on guidance over its electronic health records incentive program's meaningful use requirements have made it difficult for the provider community to meet moving targets and resulted in delayed rules implementation, says Julia Hesse of Choate Hall & Stewart LLP.

  • 9th Circ. Must Apply Dynamic Analysis To St. Luke's

    David Balto

    Next week, the Ninth Circuit will hear oral argument in the St. Luke's Health System Ltd. merger case, which many consider the most significant health care antitrust case in years. When viewed through the U.S. Supreme Court's dynamic, forward-looking approach in U.S. v General Dynamics, it is clear that sound antitrust law and policy and the facts require a reversal, says David Balto, former policy director of the Federal Trade Com... (continued)

  • CLOs: Fight Fraud With Better Analytics

    An emerging use of data analytics still atypical of corporate legal departments is "enterprise fraud and misuse management." From unearthing fraud and waste among employees to gauging Foreign Corrupt Practices Act compliance, a strong EFM program can absolutely affect a company’s bottom line. Gregory Swinehart of Deloitte Financial Advisory Services LLP explains how chief legal officers can adapt.