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Health
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November 20, 2025
Blue Shield Of California, Magellan Sued Over 'Ghost Network'
Blue Shield of California and Magellan Health maintain a "ghost network" directory of mental health providers who don't exist or don't accept new patients, leading customers to hit a dead end or desperately resort to expensive out-of-network providers, according to a proposed class action filed Wednesday in California federal court.
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November 20, 2025
10th Circ. Weighs Colo. Law On Healthcare Sharing Plans
A Tenth Circuit panel grappled Thursday with how the court should interpret a Colorado law requiring entities not authorized to offer insurance in the state to report certain information about their healthcare sharing plans, in an appeal by a religious trade group challenging the law's constitutionality.
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November 20, 2025
NC Judge Halts Medicaid Cuts For Autism Services
A North Carolina state court judge blocked the state's Health and Human Services Department from implementing a 10% cut to Medicaid reimbursement rates for autism therapy after finding children who benefit from that therapy would be irreparably harmed.
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November 20, 2025
Ute 'Healer' Convicted Of Sexual Abuse Over 12 Years
A Colorado tribal member has been convicted of sexually assaulting four women and a child over the past dozen years, the U.S. Department of Justice says, after he allegedly established himself as a traditional Indigenous healer to exploit his victims.
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November 20, 2025
Claims Firms Barred From Misleading Plaintiffs In Pharma MDL
On the same day that a Philadelphia federal judge approved $58 million in settlements as part of an ongoing generic-drug price-fixing multidistrict litigation, she also ordered several claims recovery firms to correct allegedly false and misleading ads used to attract potential clients seeking to make claims on the settlements.
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November 20, 2025
Trump Pardons Nursing Home Owner In $39M Tax Fraud
President Donald Trump granted clemency to a nursing home operator who had been sentenced to three years in prison for a $39 million employment tax fraud scheme involving care centers he owned across the country.
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November 20, 2025
Hospital's Challenge To EEOC Disability Bias Suit Falls Short
A Michigan hospital can't escape a U.S. Equal Employment Opportunity Commission suit claiming it unlawfully refused to transfer a nurse with a metabolic disorder to a less demanding position, with a federal judge saying the hospital hadn't shown the court erred when it sent the case to a jury.
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November 20, 2025
2 Firms Guide Abbott's $23B Deal With Cologuard Maker
Wachtell Lipton Rosen & Katz and Skadden Arps Slate Meagher & Flom LLP are steering Abbott's planned $23 billion acquisition of Exact Sciences, in a deal announced Thursday that will give the medical device maker an immediate foothold in fast-growing U.S. cancer screening markets.
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November 19, 2025
Senior Living Co. Inks $7.2M Deal To End Wash. AG's Probe
Oregon-based senior living provider Bonaventure will invest $7 million in staffing and upgrades and shell out $200,000 in resident credits to resolve allegations of substandard care at 10 Washington state facilities, under a settlement filed Wednesday.
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November 19, 2025
DaVita Reaches Tentative Deal In Patients' Data Breach Suit
DaVita Inc. has reached a settlement in principle with current and former patients of the healthcare company who alleged in Colorado federal court that it did not adequately protect their personal information, resulting in an April data breach.
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November 19, 2025
Fla. Congresswoman Accused Of Stealing $5M In FEMA Funds
A Florida congresswoman was indicted on charges that she stole $5 million in COVID-19 disaster relief funds through her family-run healthcare business and used the money to fund her 2021 campaign, federal prosecutors said on Wednesday.
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November 19, 2025
Med Co. Sellers Urge Del. Justices To Revive Suit
An attorney for former investors in urgent care provider CityMD urged Delaware's Supreme Court on Wednesday to reverse a lower court's dismissal of claims they were coerced into giving up purported rights to the same consideration a private equity controller received in a 2021 merger.
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November 19, 2025
Is 'Red Book' Best For Drug Pricing? Pa. Justices Ask
The Pennsylvania Supreme Court seemed skeptical Wednesday that the state workers' compensation authorities were using the best guide to calculate pharmacy reimbursements for injured workers' prescription drugs, with the justices questioning the fairness of the industry's long-used "red book" method.
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November 19, 2025
11th Circ. Backs Kaiser In Air Ambulance Arbitration Dispute
The Eleventh Circuit on Wednesday declined an air ambulance company's bid to scrap an arbitrator's ruling that Kaiser only owes $24,000 for an emergency helicopter flight, rejecting the emergency medical provider's arguments that the insurer committed fraud by strategically lowballing the arbitrator.
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November 19, 2025
23andMe Seeks OK For Ch. 11 Plan With Release Tweaks
Attorneys for former DNA testing company 23andMe urged a Missouri bankruptcy judge Wednesday to approve its Chapter 11 liquidation plan, which resolved objections from states and the U.S. Trustee tied to claim releases.
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November 19, 2025
Aetna Gets OK For $3.4M Deal In Cancer Treatment Denial Suit
A Florida federal judge has signed off on Aetna's $3.4 million settlement agreement resolving a class action that alleged the insurer unlawfully mischaracterized a proton beam cancer radiation treatment as experimental to deny dozens of claims.
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November 19, 2025
Senate GOP Resists Extending Expanded ACA Tax Premiums
Senate Finance Committee Democrats on Wednesday urged their Republican counterparts to extend the enhanced tax credits for the Affordable Care Act, which is set to expire at the end of the year, but Republicans said they were looking for other options to address rising healthcare costs.
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November 19, 2025
Conn. Dentists Pay $714K To Settle Patient Kickback Claims
Two Connecticut dentists will pay more than $714,000 to the state and federal governments to settle joint allegations that their practices submitted false government benefits claims that contained kickbacks for patient recruiters.
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November 19, 2025
Pa. Health Network's $1.15M 401(k) Suit Deal Gets Initial OK
A healthcare system Wednesday secured initial approval from a Pennsylvania federal court for a $1.15 million settlement agreement that would resolve a proposed class action alleging the company misused forfeited retirement plan funds and allowed the plan's administrative costs to soar.
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November 19, 2025
Alkermes, Avadel Bump Deal To $2.37B After Alternate Bid
Alkermes PLC said on Wednesday that its agreement to purchase Avadel Pharmaceuticals PLC has been increased to as much as $2.37 billion after a third party threw an alternate bid into the mix.
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November 19, 2025
8th Circ. Hears PBMs' Bid To Pause FTC Insulin Pricing Case
An Eighth Circuit panel had only a handful of questions on Wednesday for the pharmacy benefit managers accused of inflating insulin prices, though one of the judges expressed skepticism about pausing the Federal Trade Commission's in-house enforcement action on constitutional grounds.
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November 19, 2025
Gilead Sciences' GC Will Leave Co. Next Month
Gilead Sciences Inc. announced Wednesday that Deborah H. Telman will no longer serve as its executive vice president for corporate affairs and general counsel as of Dec. 5, 2025.
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November 19, 2025
Hospice Co. Should Face Tobacco Fee Suit, Judge Says
A hospice and home healthcare provider shouldn't escape a proposed class action challenging a tobacco surcharge in its employee health plan, a Pennsylvania federal judge recommended, finding that allegations sufficiently backed up that a wellness program implementing the fee didn't meet all regulatory requirements.
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November 19, 2025
Doctor, Husband Admit $16M Healthcare Fraud, Tax Evasion
A physician and her husband admitted to committing more than $16 million in healthcare fraud and tax evasion as part of a scheme that injected sick patients with the wrong medications or dosages, according to their plea agreements in Alaska federal court.
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November 19, 2025
Pfizer To Pay $41.5M To Settle Adulterated ADHD Drug Claims
Pfizer Inc. and Tris Pharma Inc. agreed Wednesday to cough up $41.5 million to settle claims brought by Texas that it gave adulterated ADHD drugs to children, ending a lawsuit alleging the companies violated a state healthcare fraud law.
Expert Analysis
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Pharma Copay Programs Raise Complex Economic Questions
The growing prevalence of copay accumulator and maximizer programs in the pharmaceutical industry is drawing increased scrutiny from patients, advocacy groups, lawmakers and courts, bringing complex questions about how financial responsibility for prescription drug purchases is determined and complicating damages assessments in litigation, say analysts at Analysis Group.
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State False Claims Acts Can Help Curb Opioid Fund Fraud
State versions of the federal False Claims Act can play an important role in policing the misuse of opioid settlement funds, taking a cue from the U.S. Department of Justice’s handling of federal fraud cases involving pandemic relief funds, says Kenneth Levine at Stone & Magnanini.
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'Occurrence' Lessons From Policyholder's COVID Ruling Win
The Minnesota Court of Appeals recently handed policyholders an important win in Life Time v. Zurich American Insurance, reversing a trial court ruling that had capped coverage under a communicable disease endorsement at a single occurrence, showing the importance of fact-specific inquiry, say attorneys at Hunton.
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Series
Writing Musicals Makes Me A Better Lawyer
My experiences with writing musicals and practicing law have shown that the building blocks for both endeavors are one and the same, because drama is necessary for the law to exist, says Addison O’Donnell at LOIS Law.
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Series
Adapting To Private Practice: From Va. AUSA To Mid-Law
Returning to the firm where I began my career after seven years as an assistant U.S. attorney in Virginia has been complex, nuanced and rewarding, and I’ve learned that the pursuit of justice remains the constant, even as the mindset and client change, says Kristin Johnson at Woods Rogers.
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Transmission Security Has A Critical Role In Healthcare
In light of the U.S. Department of Health and Human Services' Office of Civil Rights' continuing enforcement initiative focusing on businesses' accurate and thorough security risk assessments under the Health Insurance Portability and Accountability Act, covered entities should not neglect the importance of transmission security, says John Howard at Clark Hill.
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Rebutting Price Impact In Securities Class Actions
Defendants litigating securities cases historically faced long odds in defeating class certification, but that paradigm has recently begun to shift, with recent cases ushering in a more searching analysis of price impact and changing the evidence courts can consider at the class certification stage, say attorneys at Katten.
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7 Document Review Concepts New Attorneys Need To Know
For new associates joining firms this fall, stepping into the world of e-discovery can feel like learning a new language, but understanding a handful of fundamentals — from coding layouts to metadata — can help attorneys become fluent in document review, says Ann Motl at Bowman and Brooke.
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FTC Actions Highlight New Noncompete Enforcement Strategy
Several recent noncompete-related actions from the Federal Trade Commission — including its recent dismissal of cases appealing the vacatur of a Biden-era noncompete ban — reflect the commission's shift toward case-by-case enforcement, while confirming that the agency intends to remain active in policing such agreements, say attorneys at Debevoise.
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Ruling On Labor Peace Law Marks Shift For Cannabis Cos.
Currently on appeal to the Ninth Circuit, an Oregon federal court’s novel decision in Casala v. Kotek, invalidating a state law that requires labor peace agreements as a condition of cannabis business licensure, marks the potential for compliance uncertainty for all cannabis employers in states with labor peace mandates, say attorneys at Sheppard Mullin.
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Deference Ruling Could Close The FAR Loophole
A recent U.S. Court of Federal Claims decision may close a loophole in the Federal Acquisition Regulation that allows agencies to circumvent the Trade Agreements Act, significantly affecting federal pharmaceutical procurements and increasing protests related to certain Buy American Act waivers, say attorneys at Polsinelli.
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Agentic AI Puts A New Twist On Attorney Ethics Obligations
As lawyers increasingly use autonomous artificial intelligence agents, disciplinary authorities must decide whether attorney responsibility for an AI-caused legal ethics violation is personal or supervisory, and firms must enact strong policies regarding agentic AI use and supervision, says Grace Wynn at HWG.
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When AI Denies, Insurance Bad Faith Claims May Follow
Two recent rulings from Minnesota and Kentucky federal courts signal that past statements about claims-handling practices may leave insurers using artificial intelligence programs in claims administration vulnerable to suits alleging bad faith and unfair trade practices, say attorneys at Cozen O'Connor.
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Health Insurance Kickback Cases Signal Greater Gov't Focus
A series of recent indictments by federal prosecutors in California suggests that the Eliminating Kickbacks in Recovery Act is gaining momentum as an enforcement tool against illegal inducement of patient referrals in the realm of commercial health insurance, say attorneys at BakerHostetler.
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FDA Transparency Plans Raise Investor Disclosure Red Flags
The U.S. Food and Drug Administration’s recently announced intent to publish complete response letters for unapproved drugs and devices implicates certain investor disclosure requirements under securities laws, making it necessary for life sciences and biotech companies to adopt robust controls going forward, say attorneys at Arnold & Porter.