Policy & Compliance

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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%.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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

  • Drug Kickback Ruling Will Make FCA Liability Harder To Prove

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    The First Circuit's ruling in U.S. v. Regeneron Pharmaceuticals, requiring the government to prove but-for causation to establish False Claims Act liability based on violations of the Anti-Kickback Statute, raises the bar for FCA enforcement and deepens a circuit split that the U.S. Supreme Court may need to resolve, say attorneys at Baker Donelson.

  • Assessing PE Risk After Mass. False Claims Act Amendments

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    A law recently passed in Massachusetts amends the commonwealth's False Claims Act by dramatically expanding potential liability for private equity firms and investors, underscoring the importance of robust diligence and risk assessments for private equity firms conducting transactions in the commonwealth, say attorneys at Gibson Dunn.

  • What Trump Actions Mean For Federal Research Funding

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    New guidance from the National Institutes of Health represents a massive policy shift regarding federal funding for researchers at institutions of higher education, contributing to a perfect storm of significant resource shortfalls in upcoming years, say attorneys at Arnold & Porter.

  • A Look At Healthcare Transaction Oversight In Oregon

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    Understanding Oregon's enforcement authority and its impact on proposed transactions last year provides a road map to the state's plans to strengthen its processes this year, though enforcement could be challenged by ongoing litigation, say attorneys at Ropes & Gray.

  • Rethinking 'No Comment' For Clients Facing Public Crises

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    “No comment” is no longer a cost-free or even a viable public communications strategy for companies in crisis, and counsel must tailor their guidance based on a variety of competing factors to help clients emerge successfully, says Robert Bowers at Moore & Van Allen.

  • High Court Must Acknowledge US History Of Anti-Trans Laws

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    Despite Justice Amy Coney Barrett's claim to the contrary during oral arguments in U.S. v. Skrmetti, U.S. governments at every level have systematically discriminated against transgender people, and the U.S. Supreme Court must consider this historical context in upcoming cases about transgender issues, says Paisley Currah at the City University of New York.

  • The Fate Of Biden-Era Clinical Study Guidance Under Trump

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    Draft guidance about the study of sex and gender differences in medical product development issued by the outgoing Biden administration currently faces significant uncertainty and litigation potential due to the Trump administration's executive orders and other actions, say attorneys at Arnold & Porter.

  • 10 Issues To Watch In Aerospace And Defense Contracting

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    This year, in addition to evergreen developments driven by national security priorities, disruptive new technologies and competition with rival powers, federal contractors will see significant disruptions driven by the new administration’s efforts to reduce government spending, regulation and the size of the federal workforce, say attorneys at Thompson Hine.

  • Dispelling 10 Myths About Health Provider-Based Compliance

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    Congress appears intent on requiring hospitals to submit provider-based attestations for all off-campus outpatient hospital locations, so now is the time for hospitals to prepare for this change by understanding common misconceptions about provider-based status and proactively correct noncompliance, say attorneys at McDermott.

  • A Look At HHS' New Opinion On Patient Assistance Programs

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    A recent advisory opinion from the U.S. Department of Health and Human Services' Office of Inspector General follows a recent trend of blessing patient assistance program arrangements that implicate the Anti-Kickback Statute, as long as they are structured with appropriate safeguards to minimize the risk of fraud and abuse, say attorneys at Sheppard Mullin.

  • 2 Anti-Kickback Developments Hold Lessons For Biopharma

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    The U.S. Department of Justice's Anti-Kickback Statute settlement with QOL Medical and a favorable advisory opinion from the U.S. Department of Health and Human Services provide a study in contrasts, but there are tips for biopharma manufacturers trying to navigate the vast compliance space between them, says Mary Kohler at Kohler Health Law.

  • Tips For Pharma-Biotech Overlap Reporting In New HSR Form

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    While there’s no secret recipe for reporting overlaps to the Federal Trade Commission in the new Hart-Scott-Rodino Act form, there are several layers of considerations for all pharma-biotech companies and counsel to reflect on internally before reporting on any deal, say attorneys at A&O Shearman.

  • A Look At Drug Price Negotiation Program's Ongoing Impact

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    More than two years after the passage of the Inflation Reduction Act and the rapid implementation of the drug price negotiation program, attorneys at Ropes & Gray discuss how the IRA has influenced licensing strategies, and how maximum fair prices under the law have economically affected certain drugs.