Policy & Compliance

  • June 10, 2024

    Mass. Nursing Home To Pay Record $4M Over Neglect Claims

    A Massachusetts nursing home operator has agreed to pay a total of $4 million and hire an independent monitor to settle allegations that understaffing at its 16 facilities led to substandard care and patients being harmed, the attorney general’s office announced Monday. Next Step Healthcare LLC has agreed pay $750,000 directly to the state and dedicate the remaining $3.25 million toward increasing staffing levels.

  • June 10, 2024

    High Court To Review HHS Hospital Pay Formula

    The U.S. Supreme Court on Monday agreed to review a D.C. Circuit decision siding with the Department of Health and Human Services over how the agency applies a formula for calculating disproportionate share hospital payments for Supplemental Security Income benefits.

  • June 07, 2024

    Conn. Judge Pushes State For Proof In $11M Kickback Case

    The Connecticut state judge presiding over an $11 million false claims and kickbacks case against a compounding pharmacy appeared unconvinced Friday that the defendants submitted false claims for payment, peppering the government's counsel with requests to support assertions with case law and evidence that was put on at trial.

  • June 07, 2024

    Chicago-Area Man Charged With $60M COVID Test Fraud

    A suburban Chicago man is facing healthcare fraud and money laundering charges over more than $60 million in Medicare reimbursement claims for over-the-counter COVID-19 test kits that were allegedly never provided, including thousands of tests for dead people.

  • June 07, 2024

    7 Health Insurers Eye Rate Hikes In Connecticut

    Seven health insurers have asked Connecticut state regulators to approve rate hikes of 7.4% to 12.5% for individual market plans and 5.1% to 13.6% for small groups, averaging out to a lesser increase than last year's, according to an announcement Friday.

  • June 06, 2024

    Chronic Care Co. To Pay $14.9M To End DOJ False Claims Suit

    A provider of chronic disease management services across several states has reached a $14.9 million settlement with the U.S. Department of Justice, resolving a False Claims Act suit alleging it defrauded Medicare and Medicaid by "upcoding" healthcare claims.

  • June 06, 2024

    Justices Say Feds Liable For Tribes' Healthcare Admin Costs

    A split U.S. Supreme Court on Thursday held that the federal government is required to reimburse two Native American tribes millions of dollars in administrative healthcare costs, saying the spending is necessary for the communities to operate programs assumed from the Indian Health Service.

  • June 05, 2024

    House Votes To Block Vets' Access To Gender-Affirming Care

    The U.S. House of Representatives on Wednesday passed a $147.5 billion spending bill along mostly party lines funding military construction and the U.S. Department of Veterans Affairs, which would block veterans' access to gender-affirming care and which the White House has already threatened to veto.

  • June 05, 2024

    Calif. Wage Hike To Cover Nearly All Healthcare Workplaces

    Nearly all workers at healthcare facilities in California will be entitled to a higher minimum wage beginning July 1 regardless of whether they're involved in patient care. One expert called the increase a sweeping change, partly due to broad definitions of what employees and facilities are covered.

  • June 04, 2024

    Divided 9th Circ. Reverses Sutter Health Antitrust Trial Victory

    A split Ninth Circuit panel on Tuesday overturned Sutter Health's win in insurance plan purchasers' $400 million antitrust suit, ruling that the lower court wrongly excluded "highly relevant" evidence — including admissions by Sutter executives — that would've helped the purchasers potentially prove claims they overpaid thanks to Sutter's anticompetitive conduct.

  • June 04, 2024

    Texas Justices Fuel Confusion Over Abortion Ban Exceptions

    The Texas Supreme Court recently ruled that doctors may perform abortions only when "reasonable medical judgment" says a patient's life is in danger — a decision attorneys say puts doctors in the position of weighing the lives of their patients against the risk of criminal prosecution.

  • June 04, 2024

    FDA Advisers Rebuff Bid To Treat PTSD With MDMA

    A panel of public health experts on Tuesday dealt a blow to a historic effort to regulate MDMA therapy for post-traumatic stress disorder, saying although the positive effects shown in clinical trials are promising, the proposal was hindered by too many confounding factors.

  • June 04, 2024

    HHS Guidance, Feud Over FCA Evidence, And A Deposed AG

    States sue the Biden administration over nondiscrimination guidance. A False Claims Act case sees a tussle over evidence. A Connecticut federal judge allows drugmakers to depose the office of D.C.'s attorney general. Here, Law360 Healthcare Authority looks at notable developments in healthcare litigation over the past week.

  • June 04, 2024

    Ga. County Wants 11th Circ. To Rethink Trans Care Ban Ruling

    A Georgia county that lost a legal challenge to a provision of its health plan that bars coverage for gender-affirming surgery has asked the full Eleventh Circuit to revisit the decision, arguing that an opinion last month wrongly found the policy discriminates against transgender people, rather than being isolated to a single procedure.

  • June 04, 2024

    2nd Circ. Says ERISA Blocks Cigna Bill Backpedaling Suit

    The Second Circuit affirmed the dismissal of a podiatric medicine provider's suit alleging Cigna illegally backtracked on covering a patient's $200,000 bill, ruling that a lower court was right to find that federal benefits law blocks the healthcare provider's breach of contract claims.

  • June 04, 2024

    5th Circ. Medical 'Disinformation' Decision: 5 Things To Know

    A divided 5th Circuit gave a conservative medical group that says it was hurt by a campaign to suppress criticism of Dr. Anthony Fauci another shot at its free-speech claims. Here are five things you should know about the case.

  • June 04, 2024

    Benefits Plan Inks Deal To End Mental Health Coverage Suit

    The employee benefits plan at Mountain Area Health Education Center became the last remaining defendant to reach a settlement in a North Carolina district court lawsuit accusing an insurer and others of refusing to cover the cost of a patient's stay at a residential treatment center.

  • June 04, 2024

    What Clinical Trial Attys Want From FDA Diversity Guidance

    Impending federal guidance on diversifying clinical trial participation marks the latest push to address the historic homogeneity of clinical research. Here, clinical trial attorneys share with Law360 Healthcare Authority the questions they hope the FDA will answer.

  • June 04, 2024

    White House Threatens Veto Over Policy Riders In VA Bill

    The White House has threatened to veto a $147.5 billion bill funding military construction and the U.S. Department of Veterans Affairs, citing partisan policy proposals it said would harm minority groups and risk patient safety at VA medical facilities.

  • June 04, 2024

    Ex-Keller & Heckman Scientist Joins K&L Gates In DC

    K&L Gates LLP announced Tuesday that a longtime scientist at Keller and Heckman LLP joined its Washington, D.C., office as the firm's first senior scientific adviser.

  • June 04, 2024

    NM Cannabis Co. Says Insurers Can't Toss Medical Weed Row

    A group of insurers can't escape a proposed class action demanding they cover medical marijuana costs, a cannabis company and several of its patients said, telling a New Mexico federal court that medical cannabis is a medically necessary behavioral health service that must be covered.

  • June 04, 2024

    Sens. Offer Stark Takes On Abortion Two Years Post-Dobbs

    Republican and Democratic members of the Senate health committee on Tuesday offered two different views of abortion in America two years after the Dobbs Decision overturned the federal right to the procedure.

  • June 04, 2024

    Recent Foley Hoag Addition Tapped As Life Sciences Co-Chair

    Boston-based Foley Hoag LLP announced the appointment of a recently hired patent partner as co-chair of its life sciences industry group, the largest industry sector it services.

  • June 04, 2024

    A Lawsuit 'Field Day' Over Calif. Healthcare Worker Wage Hike

    Even before going into effect, California's new healthcare worker minimum wage is generating complex legal questions about its scope and predictions of legal clashes to come.

  • June 03, 2024

    Colo. Gov Signs Compromise Bill Raising Damages Caps

    Colorado Gov. Jared Polis on Monday signed a law that will increase statutory caps on noneconomic damages for wrongful death and injury claims, as part of a deal to avoid a ballot-box fight between medical providers and personal injury lawyers.

Expert Analysis

  • Legal Profession Gender Parity Requires Equal Parental Leave

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    To truly foster equity in the legal profession and to promote attorney retention, workplaces need to better support all parents, regardless of gender — starting by offering equal and robust parental leave to both birthing and non-birthing parents, says Ali Spindler at Irwin Fritchie.

  • Activist Short-Sellers Are The Dark Knights Of Wall Street

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    While so-called activist short-sellers have been subject to increased scrutiny in recent years, these investors work in the shadows like Batman to expose fraud on Wall Street, often generating leads that may move regulators to take action, say attorneys at Labaton Sucharow.

  • Steps Toward A Unified Health Financing System For Calif.

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    A new law authorizes the secretary of the California Health and Human Services Agency to move forward with designing a unified healthcare financing system, though the notable absence of healthcare payers in the law's list of specified stakeholders raises questions about the state's position regarding private payer options, says Ima Nsien at Squire Patton.

  • Writing Thriller Novels Makes Me A Better Lawyer

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    Authoring several thriller novels has enriched my work by providing a fresh perspective on my privacy practice, expanding my knowledge, and keeping me alert to the next wave of issues in an increasingly complex space — a reminder to all lawyers that extracurricular activities can help sharpen professional instincts, says Reece Hirsch at Morgan Lewis.

  • What Lawyers Must Know About Calif. State Bar's AI Guidance

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    Initial recommendations from the State Bar of California regarding use of generative artificial intelligence by lawyers have the potential to become a useful set of guidelines in the industry, covering confidentiality, supervision and training, communications, discrimination and more, say attorneys at Debevoise.

  • Industry Must Elevate Native American Women Attys' Stories

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    The American Bar Association's recent research study into Native American women attorneys' experiences in the legal industry reveals the glacial pace of progress, and should inform efforts to amplify Native voices in the field, says Mary Smith, president of the ABA.

  • White House Activity Is A Band-Aid For Regulating AI In Health

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    In the medium term, recent White House actions will have a greater impact on AI in the health care industry than Congress' sluggish efforts to regulate it, but ultimately legislation of AI's development and use in the health space will fall to Congress, say Wendell Bartnick and Vanessa Perumal at Reed Smith.

  • Understanding Discovery Obligations In Era Of Generative AI

    Excerpt from Practical Guidance
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    Attorneys and businesses must adapt to the unique discovery challenges presented by generative artificial intelligence, such as chatbot content and prompts, while upholding the principles of fairness, transparency and compliance with legal obligations in federal civil litigation, say attorneys at King & Spalding.

  • How Mental Health Ruling Paves Road For Equal Coverage

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    The Tenth Circuit’s recent ruling in E.W. v. Health Net, which clarified the pleading requirements necessary to establish a Mental Health Parity and Addiction Equity Act violation, is a win for plaintiffs as it opens the door to those who have been denied coverage for behavioral health treatment to prove a mental health parity violation, says Mark DeBofsky at DeBofsky Law.

  • ESG Around The World: Mexico

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    ESG has yet to become part of the DNA of the Mexican business model, but huge strides are being made in that direction, as more stakeholders demand that companies adopt, at the least, a modicum of sustainability commitments and demonstrate how they will meet them, says Carlos Escoto at Galicia Abogados.

  • The Case For Post-Bar Clerk Training Programs At Law Firms

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    In today's competitive legal hiring market, an intentionally designed training program for law school graduates awaiting bar admission can be an effective way of creating a pipeline of qualified candidates, says Brent Daub at Gilson Daub.

  • 10 Takeaways From New HHS Federal Compliance Guidelines

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    The U.S. Department of Health and Human Services' recently issued general compliance program guidance is the first of its kind that would apply across all health care stakeholders, and signals the agency’s first step to improve and update existing compliance guidance, says Melissa Wong at Holland & Knight.

  • 2 HHS Warnings Highlight Anti-Kickback Risks For Physicians

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    Two recent advisory opinions issued by the U.S. Department of Health and Human Services' Office of Inspector General involve different scenarios and rationales, but together they illustrate the OIG's focus on and disapproval of contractual joint ventures and other revenue-maximizing physician arrangements, say Robert Threlkeld and Elliott Coward at Morris Manning.