Policy & Compliance
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April 01, 2025
Fla. Defends Sandoz Price-Fixing Settlement Terms
Florida defended its deal with Sandoz Inc. on Monday, saying the other states suing the generic-drug maker over price-fixing have no right to object to the settlement, which does not require court approval and does not affect the states objecting to it.
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April 01, 2025
Tenn. PBM Statute Conflicts With ERISA, Judge Says
Tennessee law requiring pharmacy benefits managers to accept "any willing pharmacies" into their network clashes with the Employee Retirement Income Security Act, a federal judge ruled, saying the state can't enforce its statute against McKee Foods Corp. or other plans governed by the federal benefits law.
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April 01, 2025
Ex-Biotech CEO Wrongly Sentenced To 7 Years, DC Circ. Told
A former biotech executive who pled guilty to misleading investors about a blood-based COVID-19 test urged the D.C. Circuit to order a redo of his seven-year prison sentence on Tuesday, telling an appeals panel that the trial court miscalculated the sentencing guidelines.
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April 01, 2025
Top Court Abortion Case Sets High Stakes For Medicaid
The U.S. Supreme Court is set to hear arguments Wednesday in a case over South Carolina's attempt to exclude a Planned Parenthood chapter from Medicaid, weighing whether patients can take state officials to court over the Medicaid Act's "free choice of provider" provision. Experts say the outcome could have a broad impact on state authority to say which providers can or cannot treat low-income patients, and how.
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April 01, 2025
Medicaid Changes May Intensify State AG FCA Enforcement
After decades of increasing False Claims Act enforcement in the healthcare industry, relators and defense counsel alike are now bracing for even more activity by state attorneys general as a federal push to cut spending could leave state taxpayers bearing more Medicaid costs.
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April 01, 2025
23 States Sue HHS To Stop $11B In Health Grant Funding Cuts
Twenty-three states and the District of Columbia on Tuesday accused the Trump administration of illegally terminating about $11 billion in public health funding, causing layoffs and "chaos" in public health agencies across the country.
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March 31, 2025
Doc Loses Redo On Claims Hospital Lies Fueled Murder Case
A Michigan federal judge has dismissed a former Ohio physician's second attempt at suing the parent company of his ex-employer on allegations it fed prosecutors lies about his opioid prescribing practices that led to him being charged with 25 counts of murder, saying the lawsuit didn't fix the gaps left in the first case.
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March 31, 2025
Despite 'Admirable' Effort, Vertex Kickback Challenge Fails
A D.C. federal judge dealt a loss on Monday to gene therapy drugmaker Vertex Pharmaceuticals, ruling in favor of a U.S. Department of Health and Human Services advisory opinion that found the company's fertility preservation program could potentially violate the Anti-Kickback Statute.
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March 31, 2025
DocGo Can't Nix Investor Suit Over 'Indisputably False' Claims
A New York federal judge has trimmed a proposed class action alleging that mobile medical provider DocGo and its top brass misled stockholders before its $432 million migrant-services contract with New York City faced public scrutiny, but the judge found that claims stemming from the former CEO's "indisputably false" statements can proceed.
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March 31, 2025
Cuomo Defeats Suit Over NY Nursing Home COVID-19 Deaths
A New York federal judge threw out on Monday a proposed class action blaming former Gov. Andrew Cuomo and other Empire State officials for COVID-19 deaths in nursing homes, saying the claims are legally deficient and "the court's sympathy for plaintiffs and their loved ones simply cannot supplant governing law."
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March 29, 2025
Up Next At High Court: Terror Liability, Health Provider Choice
The U.S. Supreme Court will return to the bench this week to consider whether a federal law subjecting Palestinian government organizations to federal jurisdiction violates due process principles and if the Medicaid Act's provider choice provision allows individual benefit recipients to sue states over the disqualification of healthcare providers.
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March 28, 2025
Colo. Beats Amgen's Drug Price Cap Challenge, For Now
A Colorado federal judge Friday threw out Amgen's challenge to the Centennial State's drug price cap system, finding that Amgen is not subject to "direct regulation" under the law it's challenging and therefore doesn't have standing to sue.
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March 28, 2025
Janssen Owes Additional $1.5B In HIV Prescription Trial
A New Jersey federal judge on Friday added nearly $1.3 billion in penalties and $240 million in damages to a whistleblower False Claims Act verdict against Janssen over the off-label marketing of two HIV medicines, saying trial evidence laid out "a deliberate and calculated scheme."
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March 28, 2025
Plan Administrator Wins Electric Co.'s Union Healthcare Fight
An electric company can't use the Employee Retirement Income Security Act to claw back contributions to a union healthcare plan that weren't put toward benefits, a New York federal judge said Friday, tossing the company's suit against the plan's administrator.
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March 28, 2025
PE Firm Hits Back Against Medical Device Coating Challenge
Private equity firm GTCR BC Holdings LLC told a Federal Trade Commission in-house judge Friday the commission has a warped view of the medical device coatings market, as the firm fights a bid to block its $627 million acquisition of Surmodics Inc.
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March 28, 2025
Ex-Chicago Firefighter's Vaccine Bias Suit Fails, For Now
The city of Chicago dodged a former firefighter's lawsuit claiming he was fired for not complying with the city's COVID-19 vaccination policy after being given a religious exemption, with an Illinois federal judge ruling Friday he failed to show he was also exempt from the policy's testing requirement.
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March 28, 2025
Feds Settle NC Insurer's Medicare Reimbursement Suit
The U.S. Department of Health and Human Services has settled a North Carolina state-created insurance association's suit arguing it did not need to pay back the federal Medicare program for claims that should otherwise be covered by private insurance, and the parties jointly dismissed the matter Thursday.
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March 28, 2025
NC Biz Court Bulletin: TikTok Duel Heats Up, NIL Suit Plays On
In March, the North Carolina Business Court readied for trial in an insurance coverage dispute involving Smithfield Foods, heard why TikTok is subject to the state's jurisdiction, and allowed the Cardiac Pack's NIL suit against the NCAA to proceed while a parallel case plays out.
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March 27, 2025
Diopsys Inks $14M Deal Resolving Vision Testing FCA Claims
Medical device maker Diopsys Inc. has agreed to pay up to $14.25 million to put to rest allegations it violated the False Claims Act by submitting false Medicare and Medicaid claims for certain vision testing services, according to a U.S. Department of Justice announcement Thursday.
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March 27, 2025
DC Judge Seems Open To Fired Inspectors' Reinstatement Bid
A D.C. federal judge on Thursday questioned whether it would make practical sense to reinstate eight inspectors general fired by President Donald Trump while signaling openness to the federal watchdogs' argument that the president must follow the legally mandated process before they can be terminated.
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March 27, 2025
Fertility Co. Wants To Pull Device Maker Into Negligence Suit
A fertility products company wants two other companies to share potential liability from a Connecticut state lawsuit alleging that a recalled culture medium was responsible for the loss of embryos a couple were planning to use for in vitro fertilization.
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March 27, 2025
Feds Allowed To Weigh In On MultiPlan Pricing MDL
The federal government will be allowed to appear in multidistrict antitrust litigation targeting MultiPlan's out-of-network reimbursement rates to offer input on the legal framework for analyzing claims involving the joint use of algorithms, a practice it says poses "a growing threat" to free market competition.
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March 27, 2025
FCA Suit Alleging Unnecessary Spinal Surgeries Avoids Dismissal
A Washington federal judge declined Wednesday to toss the state and federal government's suit alleging a hospital operator made millions of dollars by submitting false claims to Medicaid and Medicare for medically unnecessary surgical procedures.
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March 27, 2025
Walgreens To Pay $2.8M For Alleged Medicaid Overcharges
Walgreens will pay $2.8 million under an agreement with federal prosecutors to settle allegations that it submitted inflated prices for some generic medications to Medicaid programs in Massachusetts and Georgia.
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March 27, 2025
DOJ's Antitrust Unit Targeting Anticompetitive Regulations
The U.S. Department of Justice launched a task force on Thursday aimed at eliminating state and federal laws and regulations that are hindering competition, with an initial focus on key sectors including housing, food and transportation.
Expert Analysis
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Whistleblowers Must Note 5 Key Differences Of DOJ Program
The U.S. Department of Justice’s recently unveiled whistleblower awards program diverges in key ways from similar programs at other agencies, and individuals must weigh these differences and look first to programs with stronger, proven protections before blowing the whistle, say Stephen Kohn and Geoff Schweller at Kohn Kohn.
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The Licensure Landscape For Psychedelics Manufacturers
As the need for bulk manufacturing of psychedelic substances grows, organizations aiming to support clinical trials or become commercial suppliers must navigate a rigorous and multifaceted journey to obtaining a license from the U.S. Drug Enforcement Administration, say Kimberly Chew at Husch Blackwell and Jaime Dwight at Promega Corp.
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OSHA Workplace Violence Citation Highlights Mitigation Steps
The Occupational Safety and Health Administration's recent citation against behavioral health company Circles of Care sheds light on the enforcement risks companies may face for failing to prevent workplace violence, and is a reminder of the concrete steps that can help improve workplace safety, say attorneys at Benesch.
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When Banks Unknowingly Become HIPAA Biz Associates
There appears to be significant confusion regarding the application of the Health Insurance Portability and Accountability Act to financial institutions when serving healthcare-related clients, so these institutions should consider undertaking several steps as a starting point in the effort to achieve compliance, say attorneys at Vorys.
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The Regulatory Headwinds Facing Lab-Developed Tests
Though the U.S. Food and Drug Administration's final rule regarding regulation of laboratory-developed tests outlines a four-year plan for ending enforcement discretion, and though this rule is currently being challenged in courts, manufacturers should heed compliance opportunities immediately as enforcement actions are already on the horizon, say attorneys at Kirkland & Ellis.
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3 High Court Rulings May Shape Health Org. Litigation Tactics
Three separate decisions from the U.S. Supreme Court's most recent term — Loper Bright, Corner Post and Jarkesy — will likely strengthen healthcare organizations' ability to affirmatively sue executive agencies to challenge regulations governing operations and enforcement actions, say attorneys at McDermott.
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A New Way Forward For COVID Vaccine Lawsuit Immunity
As Public Readiness and Emergency Preparedness Act protections for COVID-19 vaccines wane, adding those vaccines to coverage by the National Vaccine Injury Compensation Program would bolster defenses for administrators and manufacturers while also providing stronger remedies for those injured by vaccines, says Altom Maglio at MCT Law.
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Why DOJ's Whistleblower Program May Have Limited Impact
The U.S. Department of Justice’s new whistleblower pilot program aims to incentivize individuals to report corporate misconduct, but the program's effectiveness may be undercut by its differences from other federal agencies’ whistleblower programs and its interplay with other DOJ policies, say attorneys at Milbank.
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How Cos. With Chinese Suppliers Should Prep For Biotech Bill
A proposed bill to prohibit government-affiliated life sciences companies from contracting with Chinese biotech companies of concern may necessitate switching to other sources for research and supplies, meaning they should begin evaluating supply chains now due to the long lead times of drug development, say John O'Loughlin and Christina Carone at Weil Gotshal.
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FTC's Drug Middlemen Probe Highlights Ongoing Scrutiny
The Federal Trade Commission's interim staff report on its inquiry into pharmacy benefit managers suggests that the industry will remain under an enforcement microscope for the foreseeable future due to concerns about how PBMs affect drug costs and accessibility, say attorneys at Arnold & Porter.
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What Cos. Should Note In DOJ's New Whistleblower Pilot
After the U.S. Department of Justice unveiled a new whistleblower pilot program last week — continuing its efforts to incentivize individual reporting of misconduct — companies should review the eligibility criteria, update their compliance programs and consider the risks and benefits of making their own self-disclosures, say attorneys at Skadden.
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Motion To Transfer Venue Considerations For FCA Cases
Several recent decisions highlight the importance for practitioners of analyzing as early as possible whether a False Claims Act case warrants a change of venue, and understanding how courts weigh certain factors for defendants versus whistleblowers, say Ellen London at London & Stout, and Li Yu and Corey Lipton at DiCello Levitt.
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A Primer On EU's Updated Human Substance Regulations
The European Union's updated standards regarding quality and safety of substances of human origin meant for human application carry significant implications for companies that work with cells and tissues, and U.S. companies active in the EU market should pay particular attention to the import and export rules, say Geneviève Michaux and Georgios Symeonidis at King & Spalding.