Policy & Compliance

  • September 05, 2024

    9th Circ. Says Court 'Lost The Letter' In ERISA Coverage Row

    A California federal court "lost the letter" in remanded proceedings over allegations that United Behavioral Health improperly denied nearly 70,000 claims for mental health coverage, the Ninth Circuit has said in a new memorandum.

  • September 05, 2024

    Texas Says New HIPAA Rule Obstructs State Abortion Laws

    Texas has hit the federal government with a suit challenging a new privacy rule limiting the disclosure of reproductive health information to law enforcement, arguing the rule was designed to obstruct the state's ability to enforce its own laws on abortion.

  • September 05, 2024

    FTC Staff Opposes Indiana Hospital Merger

    Federal Trade Commission staff on Thursday urged Indiana's health department to reject Union Health's planned purchase of Terre Haute Regional Hospital LP from HCA Healthcare Inc.

  • September 05, 2024

    ER Doctors End Surprise Billing Battle With Harvard Pilgrim

    A medical group that staffs the emergency departments at several Connecticut hospitals on Thursday dropped a lawsuit accusing Harvard Pilgrim Health Care Inc. of improper billing practices and agreed to pay the insurer some of the costs of the litigation that was doomed by a recent Connecticut Supreme Court opinion.

  • September 05, 2024

    Pharma Co. Verrica Fails To Shed Investor Suit Over FDA OK

    A Pennsylvania federal judge has partially denied Verrica Phamaceuticals Inc.'s second request to throw out a proposed class action filed by investors who claim the company defrauded them by hiding obstacles it faced in obtaining approval from the U.S. Food and Drug Administration for its lead product.

  • September 05, 2024

    Insurance Litigation Week In Review

    The Fifth Circuit declined to revive a proposed global settlement related to the 2010 BP oil spill, a Hawaii federal judge determined a coverage dispute stemming from the 2023 Maui wildfires belonged in state court, and an Aon unit sought at least $140 million in damages from a Chinese bank.

  • September 05, 2024

    5th Circ. Pins Ex-Hospital Worker's Late Bias Charge On EEOC

    The Fifth Circuit breathed new life into a former patient care assistant's lawsuit alleging a Houston hospital fired her for reporting that colleagues called her "white trash," saying she shouldn't be faulted for a tardy presuit charge when the U.S. Equal Employment Opportunity Commission caused the delay.

  • September 04, 2024

    Medical Cos. Must Provide Doctor Names In Fla. Qui Tam Suit

    A Florida federal judge has ordered several medical companies accused of fraudulently obtaining more Medicare funding than they were owed to produce the names of doctors associated with the companies, saying the difference between employed and affiliate providers isn't relevant.

  • September 04, 2024

    10th Circ. Partially Nixes Insurer Win In Liposuction Death Suit

    The Tenth Circuit on Wednesday revived a health provider's bad faith claim against its insurer over coverage for a $60 million judgment stemming from a woman's fatal liposuction surgery, finding the claim fell within a four-year period of limitations for insurance bad faith claims.

  • September 04, 2024

    UBH Wins On Parity In Family's Mental Health Benefits Fight

    A Utah federal judge has handed mixed results to United Behavioral Health and a father whose child was partially denied coverage for mental health treatment at two residential treatment centers.

  • September 04, 2024

    Chamber Backs Gilead's Immunity In COVID Appeal

    The U.S. Chamber of Commerce and a trade association representing drug companies have urged a Michigan state appeals court to rule that Gilead Sciences is immune from a claim that a recalled batch of COVID-19 medication caused a man to suffer two strokes.

  • September 04, 2024

    Glenmark Will Pay $25M To End Feds' Price-Fixing Suit

    Glenmark Pharmaceuticals USA will pay $25 million to resolve allegations that it violated the False Claims Act by conspiring to fix the price of a generic high cholesterol drug, federal prosecutors announced Wednesday.

  • September 04, 2024

    Arnold & Porter Adds Mintz Healthcare Enforcement Leader

    After setting up shop in Boston a little less than a year ago, Arnold & Porter Kaye Scholer LLP announced Tuesday that it was welcoming the co-chair of Mintz Levin Cohn Ferris Glovsky and Popeo PC's healthcare enforcement defense group.

  • September 03, 2024

    Teva Investors Get Go-Ahead To Resume Kickbacks Class Suit

    A shareholder's certified class action against pharmaceutical company Teva can resume after being paused for two years, as the company says it is working towards a settlement with the U.S. Department of Justice over related claims it used kickbacks to raise the price of its multiple sclerosis drug Copaxone, a Philadelphia federal judge has decided.

  • September 03, 2024

    5th Circ. Grills Feds On Congress' Intent In No Surprises Act

    A Fifth Circuit panel on Tuesday challenged the federal government over its interpretation of how it applies a formula to calculate qualifying payments under a law meant to protect Americans from surprise medical bills and questioned the arbitration process over the payments that a medical association said favors insurers. 

  • September 03, 2024

    Meet The Zuckerman Spaeder Attys In Drug Rebate Battle

    A pair of Zuckerman Spaeder LLP attorneys who once oversaw changes to the 340B drug discount program during the Obama administration have teamed up again to defend the program from what they call an attempt by the pharmaceutical industry to weaken its benefits.

  • September 03, 2024

    Justices Deny Oklahoma's Bid To Block HHS Funding Cut

    The U.S. Supreme Court on Tuesday denied Oklahoma's request to stop the U.S. Department of Health and Human Services from cutting funding over the state's refusal to refer family planning patients for abortion after the high court's Dobbs decision last year.

  • September 03, 2024

    2nd Circ. Won't Ax Dad's Removal Over Child's Mental Health

    The Second Circuit ruled Tuesday that a man who entered the U.S. illegally more than two decades ago can't cancel his removal on the grounds that it would cause his daughter hardship, ruling that any adverse impacts would be typical of family separation.

  • September 03, 2024

    Ohio AG Asks Appeals Court To Affirm Trans Care Restrictions

    Ohio lawmakers acted within their authority to regulate the practice of medicine when they passed a law this year that restricts gender-affirming care for minors and prohibits transgender girls from participating in girls sports, Ohio Attorney General Dave Yost told the state appeals court in a recent brief.

  • September 03, 2024

    Will Medicaid Incarceration Waivers Hit 'Cutting Room Floor'?

    A bipartisan push to get incarcerated individuals covered by Medicaid before they're released could drastically reduce healthcare disparities and provide health equity to underrepresented populations. But shifting political winds and an upcoming election could lead to budget cuts that put the program on the "cutting room floor."

  • September 03, 2024

    'Showdown' Looms As J&J Pursues Rebates In 340B Program

    Johnson & Johnson's plan to abandon upfront discounts and instead offer rebates for two popular medications under the 340B drug pricing law would fundamentally alter how the program has worked for decades. Federal enforcement efforts and other legal clashes are likely.

  • September 03, 2024

    Glenmark Hit With $50M Suit Over Potassium Pill Death

    A proposed class of buyers is suing Glenmark Pharmaceuticals Inc. for more than $50 million, alleging that the company's extended-release potassium chloride capsules are defective and instead deliver the potassium too fast, which resulted in the death of the lead plaintiff's mother.

  • August 30, 2024

    Vets, Attys Urge Supreme Court To Topple Feres Doctrine

    Veterans groups and lawmakers contend it's "high time" for the U.S. Supreme Court to scrap its 74-year-old doctrine prohibiting military service members and their families from suing the U.S. for negligence, arguing the vague rule has left soldiers with fewer rights than prisoners and noncitizens.

  • August 30, 2024

    Connecticut Judge Wants More Info In Doctors' Billing Row

    A Connecticut federal judge on Friday declined to immediately dismiss a medical staffing company's lawsuit against Harvard Pilgrim Health Care of Connecticut Inc. after the state's highest court answered three certified questions in the insurer's favor, asking for briefs after the insurer countered with a demand for a judgment.

  • August 30, 2024

    HHS Wins Escape From Low-Income Hospital Payment Fight

    A D.C. federal judge on Friday agreed to toss a lawsuit brought by a group of hospitals against the U.S. Department of Health and Human Services challenging its Medicare payment determinations for low-income patients, finding the hospitals didn't exhaust their administrative remedies. 

Expert Analysis

  • Air Ambulance Ruling Severely Undermines No Surprises Act

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    A Texas federal court's recent decision in Guardian Flight v. Health Care Service — that the No Surprises Act lacks a judicial remedy when a health insurer refuses to pay the amount established through an independent review — likely throws a huge monkey wrench into the elaborate protections the NSA was enacted to provide, says Mark DeBofsky at DeBofsky Law.

  • Class Actions At The Circuit Courts: June Lessons

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    In this month's review of class action appeals, Mitchell Engel at Shook Hardy considers two recent decisions from the Third and Tenth Circuits, and identifies practice tips around class action settlements and standing in securities litigation.

  • How Congress Is Tackling The US Healthcare Shortage

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    With healthcare shortages continuing across the U.S. despite industry efforts to improve patient access to care, increased Medicare support for graduate medical education could be a crucial component of the solution, say Sarah Crossan and Miranda Franco at Holland & Knight.

  • The Current State Of Healthcare Transaction Reviews In Calif.

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    As of April, certain healthcare transactions in California have been subject to additional notification compliance requirements, and complying with these new rules could significantly delay and discourage some deals, says Andrew Demetriou at Husch Blackwell.

  • High Court's Abortion Pill Ruling Shuts Out Future Challenges

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    The U.S. Supreme Court's unanimous ruling in U.S. Food and Drug Administration v. Alliance for Hippocratic Medicine maintains the status quo for mifepristone access and rejects the plaintiffs' standing theories so thoroughly that future challenges from states or other plaintiffs are unlikely to be viable, say Jaime Santos and Annaka Nava at Goodwin.

  • Orange Book Warnings Highlight FTC's Drug Price Focus

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    In light of heightened regulatory scrutiny surrounding drug pricing and the Federal Trade Commission's activity in the recent Teva v. Amneal case, branded drug manufacturers should expect the FTC's campaign against allegedly improper Orange Book listings to continue, say attorneys at Ropes & Gray.

  • A Plaintiffs-Side Approach To Cochlear Implant Cases

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    As the number of cochlear implants in the U.S. continues to grow, some will inevitably fail — especially considering that many recalled implants remain in use — plaintiffs attorneys should proactively prepare for litigation over defective implants, says David Shoop at Shoop.

  • Inside Antitrust Agencies' Rollup And Serial Acquisition Moves

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    The recent request for public comments on serial acquisitions and rollup strategies from the Federal Trade Commission and U.S. Justice Department mark the antitrust agencies' continued focus on actions that fall below premerger reporting thresholds, say attorneys at Paul Weiss.

  • Short-Term Takeaways From CMS' New Long-Term Care Rules

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    The Centers for Medicare & Medicaid Services' new final rule on nursing home staffing minimums imposes controversial regulatory challenges that will likely face significant litigation, but for now, stakeholders will need to prepare for increased staffing expectations and more specialized facility assessments without meaningful funding, say attorneys at Morgan Lewis.

  • FDA's Data Monitoring Guidance Reveals Future Expectations

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    As the world of clinical research grows increasingly complex, the U.S. Food and Drug Administration's recent draft guidance on the use of data monitoring committees in clinical trials reveals how the agency expects such committees to develop, say Melissa Markey and Carolina Wirth at Hall Render.

  • FDA Warning Indicates Scrutiny Of Regenerative Health Cos.

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    The U.S. Food and Drug Administration's recent warning letter to Akan Biosciences is a quintessential example of the agency's enforcement priorities for certain products involving human cells and tissues, and highlights ongoing scrutiny placed on manufacturers, say Dominick DiSabatino and Cortney Inman at Sheppard Mullin.

  • 2 Regulatory Approaches To Psychedelic Clinical Trials

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    Comparing the U.S. and Canada's regulatory frameworks for clinical trials of psychedelic drugs can be useful for designing trial protocols that meet both countries' requirements, which can in turn help diversify patient populations, bolster data robustness and expedite market access, say Kimberly Chew at Husch Blackwell and Sabrina Ramkellawan at AxialBridge.

  • 'Food As Health' Serves Up Fresh Legal Considerations

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    The growth of food as medicine presents a significant opportunity for healthcare organizations and nontraditional healthcare players to improve patient outcomes and reduce costs, though these innovative programs also bring compliance considerations that must be carefully navigated, say attorneys at McDermott.