Policy & Compliance
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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.
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March 27, 2025
EMS Co. Accused Of Failing To Pay Proper Overtime
A private ambulance company has been hit with a proposed class action in Georgia federal court over allegations that it failed to pay workers overtime wages as required by the Fair Labor Standards Act.
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March 27, 2025
HHS To Cut 10,000 Jobs As RFK Jr. Reorganizes Agency
The U.S. Department of Health and Human Services said Thursday that it would lay off 10,000 employees as part of a "dramatic" plan to restructure the agency and downsize its workforce by about 24%.
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March 26, 2025
Sotomayor Urges Caution On Nondelegation Doctrine Revamp
U.S. Supreme Court Justice Sonia Sotomayor cautioned her colleagues during oral arguments Wednesday against using a challenge to the Federal Communications Commission's administration of a broadband subsidy program as a way to resurrect the long-dormant nondelegation doctrine. Several conservative justices, however, seemed willing to disregard that admonition.
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March 26, 2025
Healthcare Providers To Pay $63M Over False Spinal Diagnoses
California-based Seoul Medical Group, its healthcare management service unit and a radiology center will pay $62.85 million to settle allegations they submitted bogus spinal condition diagnoses to the Centers for Medicare and Medicaid Services to maximize their revenue, federal prosecutors announced Wednesday.
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March 26, 2025
Feds Seek 2 Years For Device-Maker's $2.4M Tax Evasion
A Floridian who made millions of dollars on medical devices and pled guilty to evading $2.4 million in taxes should be sentenced to between 24 and 30 months in prison for tax evasion based on the severity of his offense, the U.S. told a federal court Wednesday.
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March 26, 2025
AGs Seek 1st OK For $39M Apotex Deal In Price-Fixing Case
A coalition of 50 state attorneys general on Wednesday asked a Connecticut federal judge to accept a $39.1 million deal settling claims that pharmaceutical company Apotex Corp. schemed with others to fix generic-drug prices, with 70% earmarked for a restitution fund and 30% for consumer notices and attorney fees.
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March 26, 2025
False COVID Cure Claims No Longer Feds' 'Current Priority'
The Trump administration has abandoned another case targeting allegedly false claims that an over-the-counter product could treat, or even cure, COVID-19 by dropping its case against a one-man herbal tea operation.
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March 26, 2025
Hospital To Face Doctor's Libel Claim Over Suspension Report
A North Carolina federal judge has dismissed claims for breach of good faith and emotional distress from a gynecological oncologist's defamation suit against the hospital where he used to work, but let libel and loss of job opportunity claims continue in line with a magistrate judge's recommendation.
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March 26, 2025
BCBS Settlement Opt-Outs Ordered To Disclose Funding Deals
Four law firms representing hospitals that opted out of the landmark $2.8 billion Blue Cross Blue Shield antitrust settlement must disclose whether their clients were motivated by a "quick payment" from litigation funders, an Alabama federal judge ordered Tuesday.
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March 26, 2025
Ex-CEO Says McGuireWoods Can't Rehash Immunity Appeal
McGuireWoods LLP and one of its former partners are rehashing immunity defenses in a last-ditch effort to dodge a long-running defamation case, the former CEO of a managed care organization told the North Carolina Court of Appeals in seeking to have the case kicked back down to the trial court.
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March 25, 2025
UBH Patients On Remand, CMS Audits And J&J Investor Suit
Patients challenging United Behavioral Health coverage guidelines for mental health treatment filed their first brief in the case since the Ninth Circuit clarified the scope of the remanded proceedings.
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March 25, 2025
Anthem Can't Escape Family's Mental Health Parity Claims
Anthem Blue Cross Blue Shield must face a Virginia family's claim that the company violated a federal benefits law by refusing to cover an adolescent girl's stay in a residential mental health facility, with a Virginia federal judge deeming the suit strong enough to survive a dismissal motion Tuesday.
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March 25, 2025
Trans Military Ban Rests On 'Unconvincing' Proof, Judge Says
A Washington federal judge hinted Tuesday he might block the Trump administration's ban on transgender troops later this week, expressing doubt that the U.S. Department of Defense has evidence to back its stance that gender dysphoria alone makes people unfit for military service.
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March 25, 2025
ND Justices Weigh Liberty Rights In Abortion Ban Challenge
North Dakota's top court on Tuesday wrestled with whether a recently passed anti-abortion law violates personal liberty rights and questioned both sides about the meaning of exceptions to the ban written into the law.
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March 25, 2025
Amid Abortion Fight, Idaho Bolsters Moral Objection Rights
A new law in Idaho — already the epicenter of a national clash over emergency abortion care — expands the conscientious objection rights of doctors and health professionals.
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March 25, 2025
Antitrust In Healthcare: 3 Cases To Watch
Amid a Congressional probe into a long-standing antitrust exemption for a national medical resident matching system, a handful of healthcare groups are in court with allegations that trade organizations have violated antitrust laws.
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March 25, 2025
Experts Warn Of 'Slippery Slope' In Judge Shopping Sanctions
A federal judge's judge shopping sanctions on lawyers challenging an Alabama transgender care ban were unusually harsh, legal experts said, and raise concerns about a chilling effect on advocates litigating similar cases in other jurisdictions.
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March 25, 2025
BU Law Prof On The Evolution Of Med Mal Standard Of Care
Boston University law professor Christopher Robertson talks about the American Law Institute's first update on medical malpractice law in 60 years and the state law evolution towards a “reasonable” care standard.
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March 25, 2025
Hartford HealthCare Fights Disclosure Of Antitrust Settlement
Hartford HealthCare Corp. says it cannot be forced to reveal a confidential January antitrust settlement with another Connecticut hospital at the behest of a Teamsters health plan and a public transit agency separately accusing the consortium of creating a monopoly.
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March 25, 2025
Unnecessary Surgeries Drive Rare Va. Hospital Criminal Case
An unusual indictment in Virginia details grave allegations against a former doctor, including unnecessary surgeries and bogus cancer diagnoses. With former OB-GYN Javaid Perwaiz already in federal prison, the hospital where many of the procedures occurred is now facing criminal charges.
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March 24, 2025
Trump Picks Acting CDC Head After Weldon Nomination Fails
President Donald Trump on Monday nominated acting Centers for Disease Control and Prevention head Susan Monarez to take over as the agency's director, a move that comes after Trump pulled his nomination of Dr. Dave Weldon for the position when it became clear Weldon lacked needed support.
Expert Analysis
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CFPB's Medical Debt Proposal May Have Side Effects
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.
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15 Areas That Would Change Under Health Data Rule Proposal
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.
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3 Healthcare FCA Deals Provide Self-Disclosure Takeaways
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.
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Takeaways From High Court's Tribal Health Admin Cost Ruling
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.
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FTC Focus: Private Equity Investments In Healthcare
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.
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High Court's Expert Ruling May Help Health Fraud Defendants
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.
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Unpacking HHS' Opinion On Cell Therapy Refund Programs
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.
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DOJ Innovasis Settlement Offers Lessons On Self-Disclosure
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.
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How Orange Book Antitrust Scrutiny Is Intensifying
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.
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After Chevron: Slowing Down AI In Medical Research
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.
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FDA's Multifaceted Role On Display In MDMA Therapy Scrutiny
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.
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Analyzing FDA Draft Guidance On Clinical Trial Diversity
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.
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In The CFPB Playbook: Making Good On Bold Promises
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.