Health

  • September 28, 2016

    FTC’s Ill. Hospital Merger Suit Gets 3rd Circ. Boost

    The Third Circuit on Tuesday endorsed the government’s analysis of geographic markets in hospital mergers in siding with the U.S. Federal Trade Commission in a challenge to the combination of two Pennsylvania hospital systems, a decision that could aid the agency’s appeal of an Illinois hospital merger case.

  • September 28, 2016

    Dentists Smiling As Price-Fixing Conspiracy Case Survives

    A New York federal judge in a ruling released Wednesday refused to dismiss a proposed class action accusing dental supply distributors of a vast price-fixing conspiracy, concluding that allegations of collusion and threats have enough bite for the time being.

  • September 28, 2016

    HHS Wins Medicare Payment Fight Against Maine Hospital

    The U.S. Department of Health and Human Services was right to bar Central Maine Medical Center from amending its appeal of how much it should have been reimbursed by Medicare in 2007 because the wrong organization submitted the request, a Maine federal judge ruled Wednesday.

  • September 28, 2016

    Sens. Ask DOJ If Mylan's EpiPen Rebates Violate The FCA

    Three U.S. Senators on Wednesday asked Attorney General Loretta Lynch whether the U.S. Department of Justice is investigating possible False Claims Act violations by Mylan NV after questions arose on whether the company may be underpaying Medicaid rebates for its epinephrine injector EpiPen.

  • September 28, 2016

    PharMerica Sues Ex-Employees Over New Rival Business

    PharMerica, a pharmacy chain serving nursing homes, sued three former employees who departed to form a rival business in Pennsylvania federal court on Tuesday, claiming that they breached noncompetes and have access to trade secrets.

  • September 28, 2016

    Senate Reaches Deal To Avoid Gov't Shutdown

    The Senate pulled together a measure Wednesday that would avoid a government shutdown at the end of the week, after a deal to allow aid for Flint, Michigan’s lead-contaminated water system to proceed on a different bill.

  • September 28, 2016

    Vibra Healthcare Agrees To $33M Settlement Of FCA Claims

    Vibra Healthcare LLC, a national hospital chain headquartered in Mechanicsburg, Pennsylvania, will pay more than $32.7 million to settle U.S. Department of Justice claims that it violated the False Claims Act in billing Medicare for services that patients didn't need, the government announced on Wednesday.

  • September 27, 2016

    Ex-Hospital CEO Booted From Medicare In $1M Kickback Deal

    The former CEO of a South Carolina hospital system that settled a suit over illegal Medicare and Medicaid billings has reached a $1 million deal of his own that bans him from participating in federal health care programs for four years over Stark Law violations, prosecutors said Tuesday.

  • September 27, 2016

    DOJ Loss In AmEx Case Could Imperil Hospital Steering Suit

    The U.S. Department of Justice has touted the similarities between its antitrust cases against American Express and a North Carolina hospital system, but that comparison could come back to haunt it now that the Second Circuit has found that AmEx's anti-steering rules are not anti-competitive.

  • September 27, 2016

    Hartford, Cincinnati Beat Doc's TCPA Coverage Bid

    A Missouri federal judge has ruled that a Hartford unit and Cincinnati insurance Co. don't have to defend a Chicago-area medical office against proposed class claims that it violated the Telephone Consumer Protection Act by sending unsolicited faxes, saying the underlying allegations fall squarely within TCPA exclusions in the insurers' policies.

  • September 27, 2016

    Insurers Say Cancer Center On Its Own In Data Breach Suits

    Charter Oak Fire Insurance Co. and Travelers Property Casualty Co. of America asked a Florida federal court Monday to rule that they have no duty to defend 21st Century Oncology cancer centers in suits stemming from a September 2015 data breach that affected nearly 2 million clients.

  • September 27, 2016

    Horizon Owes $76M In Unpaid Claims, NJ Hospitals Say

    Horizon Blue Cross Blue Shield of New Jersey was hit Monday with a federal lawsuit by a network of New Jersey hospitals alleging the insurance company has underpaid or refused to pay just over $76 million for out-of-network medical care reimbursement provided to Horizon insureds, including urgent care patients.

  • September 27, 2016

    Merge Healthcare Says $1B Sale To IBM Passes Muster

    The former directors of Merge Healthcare Inc. told a Delaware Chancery Court judge Tuesday that its $1 billion sale to IBM in 2015 is compatible with state law, arguing that an investor suit challenging the deal should be dismissed.

  • September 27, 2016

    Sales Rep Wants Docs Public In $40B Celgene FCA Row

    Celgene Corp. hasn’t proven that documents it wants to seal in a $40 billion False Claims Act suit over off-label promotion of the cancer drugs Thalomid and Revlimid would be harmful if released, especially as some of them are already public, a whistleblower told a California federal court Monday.

  • September 27, 2016

    House Votes To Carve Exemption In ACA Individual Mandate

    The House of Representatives voted Tuesday to exempt former customers of failed insurance cooperatives from the Affordable Care Act's individual insurance mandate, despite a veto threat from the White House over the measure's attempt to undercut the administration's signature health care law.

  • September 27, 2016

    Senior Care Biz Can't Nix Feds' FCA Suit

    SavaSeniorCare LLC failed to dodge a massive False Claims Act suit initially brought by a whistleblower against the rehabilitation therapy company, when a Tennessee federal judge refused Tuesday to dismiss the federal government’s claims.

  • September 27, 2016

    VA Looks To Nix Ariz. Tribe's Suit Over Care Reimbursements

    The U.S. Department of Veterans Affairs continued pushing to toss the Gila River Indian Community's lawsuit accusing the VA of failing to reimburse the tribe for health care the community has provided to veterans, saying Monday that the dispute does not belong in Arizona federal court.

  • September 27, 2016

    Rainmaker Q&A: Bird Marella's Benjamin Gluck

    A well-read local blogger who was no fan of mine at all once referred to me as an “evil genius” who was “a fraudster’s dream lawyer.” That posting brought me more business than any other marketing efforts I’ve ever done, says Benjamin Gluck, principal at Bird Marella Boxer Wolpert Nessim Drooks Lincenberg & Row PC.

  • September 27, 2016

    DOJ Won't Argue ACA Harm In Anthem-Cigna Merger Trial

    The U.S. Department of Justice will abandon claims that a proposed merger between Anthem Inc. and Cigna Corp. will hurt competition on the ACA’s individual insurance marketplace to narrow the scope of the trial set to start in late November, the parties told a D.C. federal court Monday.

  • September 27, 2016

    NC Lawmakers Look To Dodge Depositions In HB 2 Suit

    North Carolina’s legislative leaders and Gov. Patrick McCrory asked a federal court Monday to recognize their legislative privilege to not be deposed by the U.S. and others suing over the state’s law requiring transgender people to use bathrooms and locker rooms corresponding to the sex on their birth certificates.

Expert Analysis

  • The Courtroom Where It Happened: Hamilton As A Lawyer

    Randy Maniloff

    Often lost in discussions about Alexander Hamilton is that he was an extremely important New York lawyer. He had an extensive law practice until his death in 1804 and he wrote what is considered to be the first treatise in the field of private law. Ultimately, Hamilton certainly did get a lot further "by working a lot harder, by being a lot smarter, by being a self-starter," says Randy Maniloff of White and Williams LLP.

  • Dudenhoeffer's Applicability To Privately Held Stock

    Chelsea Ashbrook McCarthy

    The Seventh Circuit's recent decision in Allen v. GreatBanc Trust made it the first court to expressly reject Fifth Third Bancorp v. Dudenhoeffer's application to plan investments in privately held stock. The decision clarifies a plaintiff's burden to plead a prohibited-transaction claim under Section 406 of the Employee Retirement Income Security Act, say Chelsea Ashbrook McCarthy and Louis Joseph of Holland & Knight LLP.

  • Why Have Lawyers Forgotten About The Middle Class?

    Chas.jpg

    Sorry, fellow lawyers, judges and legislators, but the jig is up. It’s time to show the public the cards up our sleeves and give them a chance to weigh in on the fairness of a system that touches so many aspects of their everyday lives, says Chas Rampenthal, general counsel of LegalZoom.

  • And Now A Word From The Panel: 3 Alternatives To MDLs

    Alan E. Rothman

    Recognizing the ever-dwindling number of multidistrict litigation proceedings, Alan Rothman of Kaye Scholer LLP explores the three alternatives to MDLs which the Judicial Panel for Multidistrict Litigation has recently considered in denying and/or mooting MDL petitions.

  • The Role Of Value And Cost In Prescription Drug Pricing

    Dr. Richard Manning

    Since the passage of Medicare Part D, controversy has surrounded the question of prescription drug prices and whether or not they should be tied to the value they provide. Though it might seem unfair for new treatments to be released at high initial prices, the promise of potential profits is necessary for motivating medical research, says Dr. Richard Manning of Bates White.

  • Small-Breach Focus Shows Growing Scope Of HIPAA Probes

    Joanna Bergmann

    Flexing more enforcement muscle, the U.S. Department of Health and Human Services recently announced it will more widely investigate breaches of protected health information affecting fewer than 500 individuals. As a result, health care providers and other covered entities and their business associates should expect an uptick in the volume of enforcement actions triggered by small-scale breaches, say attorneys with Ropes & Gray LLP.

  • You Don’t Need A Data Breach To Face Regulatory Scrutiny

    Kim Peretti

    One side effect of the rise in bug bounty programs, and disclosures by security researchers and others, is a commensurate increase in publicly known security vulnerabilities that can lead to increased scrutiny from regulators and the plaintiffs bar, says Kim Peretti, co-leader of Alston & Bird LLP's cybersecurity preparedness and response team.

  • The Perils Of Parallel FCA Proceedings

    Tony Maida

    Parallel criminal and civil proceedings in False Claims Act cases raise important and troublesome issues for the defense, including protecting the defendant’s Fifth Amendment rights while mounting a robust defense in the civil case. But, as shown in recent decisions from the Eastern District of Kentucky and Southern District of New York, parallel proceedings may also prove challenging to the U.S. Department of Justice, say Tony Mai... (continued)

  • When Ambiguous Regs Preclude FCA Liability

    Taylor Chenery

    The Eighth Circuit’s opinion in U.S. v. Anesthesia Associates is the most recent in a line of cases suggesting that a provider faced with a potentially ambiguous regulation or statute can protect itself from potential False Claims Act liability by taking steps to ensure that its interpretation of the ambiguous provision is reasonable under the circumstances, says Taylor Chenery of Bass Berry & Sims PLC.

  • Practical Uses For Machine Learning In Health Care Cases

    Mihran Yenikomshian

    Machine learning can efficiently turn enormous volumes of both structured and unstructured data into something meaningful, without losing underlying details. Consultants with Analysis Group Inc. elaborate on how machine learning can be applied in the courtroom in terms of informing legal strategy, identifying relevant materials for experts, and enhancing expert testimony in health care litigation.