Policy & Compliance
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June 27, 2025
Feds Say Transnational Crime Ring Stole $10B From Medicare
New York federal prosecutors have charged 11 members of a "transnational criminal organization, based in Russia and elsewhere," with submitting more than $10 billion worth of fraudulent Medicare claims over the last three years and funneling the proceeds overseas, according to a newly unsealed indictment.
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June 27, 2025
Pregnancy Loss Draws Police Scrutiny Following Dobbs
The nation's abortion debate has played out in civil courtrooms and state capitols across the country since the overturning of Roe v. Wade three years ago. But the battle is also emerging in another arena: the criminal courts.
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June 27, 2025
Full 5th Circ. To Hear Planned Parenthood Atty Immunity Row
The full Fifth Circuit will rehear a panel's decision concluding that Planned Parenthood is entitled to attorney immunity in a whistleblower suit accusing the organization of improperly billing Medicaid programs.
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June 27, 2025
DC Judge Says Teen Health Projects Can 'Shutter' Temporarily
Five Planned Parenthood affiliates will not be irreparably harmed by changes to federal guidance for teen health programs instructing grantees to demonstrate alignment with executive orders from the Trump administration rejecting transgender identity and diversity programs, a D.C. federal judge has ruled.
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June 27, 2025
Justices Back Task Force That Sets ACA Care Requirements
The U.S. Supreme Court ruled Friday that the U.S. Department of Health and Human Services' secretary had authority over a preventive care task force, rejecting a constitutional challenge to an Affordable Care Act clause that requires health insurers to cover certain treatments at no cost to patients.
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June 26, 2025
Nurse Wins $27M In Retaliation Case Against Dignity Health
A former chief nursing officer who sued the West Coast hospital system Dignity Health alleging she was illegally terminated for raising serious safety concerns was awarded $27.5 million from a Los Angeles jury, her attorneys announced Thursday.
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June 26, 2025
Hims & Hers Face Investor Suits Over Wegovy Collab
Telehealth company Hims & Hers Health Inc. has been hit with investors' proposed class actions accusing it of exploiting its partnership with Novo Nordisk, the distributor of weight loss drug Wegovy, to sell "knockoff" drugs, causing Hims shares to fall 35% when Novo Nordisk announced earlier this week the collaboration had been terminated.
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June 26, 2025
UHC Accused Of Withholding $2M In Claims From NC Provider
UnitedHealthcare Insurance Co. siphoned millions of dollars from a North Carolina emergency medicine provider in an "extortionate scheme" by refusing to pay its customers' emergency medical claims, the provider has alleged in North Carolina federal court.
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June 26, 2025
6th Circ. Backs Mich. Newborn Blood Testing Program
A Sixth Circuit panel reversed a win for a group of parents challenging a Michigan newborn health screening program, finding that the way blood samples are stored and used in the program does not violate the parents' right to make medical decisions for their children.
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June 26, 2025
Judge Casts Doubt On Plea Deals In Blood Test Defect Case
A set of plea agreements between Massachusetts federal prosecutors and former Magellan Diagnostics executives has been thrown into uncertainty amid a dispute over whether the executives admitted to fraud related to defective blood tests or merely an intent to mislead, a question a judge said Thursday might be "a very expensive rabbit hole."
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June 26, 2025
Ex-FDA Regulator Joins ArentFox Schiff's Pharma Practice
ArentFox Schiff LLP has hired a career U.S. Food and Drug Administration compliance professional, whose oversight focused on ensuring pharmaceutical industry participants' compliance with drug supply chain rules and other governing regulations, as counsel in the firm's food, drug, medical device and cosmetic practice in Washington.
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June 26, 2025
Former Hoops Star Telfair Gets 6 Mos. For Violating Release
A Manhattan federal judge sentenced former high school basketball star and ex-NBA player Sebastian Telfair to six months in prison Thursday for violating the terms of his supervised release, after sparing him prison last year for defrauding the league's health plan.
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June 26, 2025
Justices Say SC Medicaid Patient Can't Sue To Pick Provider
The U.S. Supreme Court on Thursday ruled that a patient can't challenge South Carolina's decision to kick Planned Parenthood from the state Medicaid program because it includes abortions among its services.
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June 25, 2025
Cigna Says Bristol-Myers Delayed Cancer Drug Generic
Cigna has launched an antitrust suit in New York federal court accusing Bristol-Myers Squibb Co. and its Celgene subsidiary of fraudulently obtaining patents, filing sham litigation and paying off generic-drug makers to maintain a monopoly on their blockbuster blood-cancer drug Pomalyst.
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June 25, 2025
Trans Worker Says Metal Co.'s Health Plan Discriminatory
A subsidiary of Kaiser Aluminum discriminated against transgender employees by including an exclusion in its health plan barring coverage for medical treatments related to gender-affirming care, according to a new suit filed in Washington federal court.
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June 25, 2025
CVS PBM Hit With $95M Judgment For Overbilling Medicare
A Pennsylvania federal judge on Wednesday ruled that CVS's pharmacy benefits manager owes the government $95 million for overbilling Medicare Part D-sponsored drugs, leaving the door open for the amount to be tripled later.
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June 24, 2025
Arkansas Insurance Dept. Fights Teamsters Plan's ERISA Suit
The Arkansas Insurance Department is looking to sink a challenge to a state insurance regulation filed by a Teamsters healthcare plan, telling an Illinois federal judge that the regulation isn't preempted by the Employee Retirement Income Security Act and, besides, the plan can't sue the department.
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June 24, 2025
Health Data Co. Must Face Revised Investor Fraud Suit
A Connecticut federal judge won't toss an amended class action claiming a healthcare technology company misled investors about a data platform it claimed to operate that didn't actually exist, ruling that statements about the platform's capabilities are not inactionable, forward-looking statements.
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June 24, 2025
4th Circ. Tosses Trans Man's Appeal Over Canceled Surgery
The Fourth Circuit declined to revive a transgender man's constitutional claims against a religious hospital run by the University of Maryland Medical System over a canceled hysterectomy for gender dysphoria, concluding Tuesday that it couldn't grant further relief, and refused to consider a "late-breaking" argument for emotional distress damages.
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June 24, 2025
Calif. AG Asks 9th Circ. To Undo Limits On Pay-For-Delay Ban
California enforcers on Monday asked the Ninth Circuit to overturn a district court's decision that a state law restricting "reverse payment" settlements between brand-name and generic-drug makers cannot be used to regulate deals that were struck outside the Golden State.
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June 24, 2025
Healthcare In Court: 5 Rulings You May Have Missed
A D.C. federal judge rejected a challenge to the federal government's approval of an audit by Johnson & Johnson into five hospitals' compliance with the 340B drug discount program. In Texas, a state appellate court has blocked San Antonio from going forward with a program that could fund travel for residents to access abortion care in other states. Here, Law360 Healthcare Authority looks at those and other healthcare rulings you may have missed over the last week.
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June 24, 2025
Nichols Liu Co-Founder Andy Liu Launches Solo Venture
Boutique firm Nichols Liu LLP's co-founding partner Andy Liu has launched a solo practice to continue representing government contractors and healthcare industry clients in civil and criminal enforcement matters, telling Law360 Pulse Tuesday he wanted to go out on his own for greater control.
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June 24, 2025
Docs Navigate 'Legal Thicket' Of Pregnancy Exclusion Laws
A first-of-its-kind lawsuit in Kansas challenges a state law that plaintiffs say undermines a woman's right to make critical end-of-life decisions while pregnant and leaves doctors legally vulnerable.
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June 24, 2025
Trump Admin Must Release NIH Funds Amid Appeal
A Massachusetts federal judge on Tuesday denied the Trump administration's request to stay a recent order that it resume processing National Institutes of Health grant applications and releasing funds, warning that even one more day of delay would lead to irreparable harm.
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June 23, 2025
Ontrak Founder Gets 3½ Years In Novel Insider Trading Case
A California federal judge sentenced Ontrak Inc. founder Terren Peizer to 3½ years in prison Monday, following a first-of-its-kind insider trading conviction on accusations that he based a $20 million share sale on material nonpublic information that his health technology company was about to lose its biggest client, Cigna.
Expert Analysis
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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.
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Critical Questions Remain After High Court's Abortion Rulings
The U.S. Supreme Court's decisions in two major abortion-related cases this term largely preserve the status quo for now, but leave federal preemption, the Comstock Act and in vitro fertilization in limbo, say attorneys at Jenner & Block.
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Navigating FDA Supply Rule Leeway For Small Dispensers
As the November compliance deadline for the U.S. Food and Drug Administration's new pharmaceutical distribution supply chain rules draws closer, small dispensers should understand the narrow flexibilities that are available, and the questions to consider before taking advantage of them, say attorneys at Faegre Drinker.
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1st Gender Care Ban Provides Context For High Court Case
The history of Arkansas' ban on gender-affirming medical care — the first such legislation in the U.S. — provides important insight into the far-reaching ramifications that the U.S. Supreme Court's decision in U.S. v. Skrmetti next term will have on transgender healthcare, says Tyler Saenz at Baker Donelson.