Policy & Compliance
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May 29, 2025
Ga. BCBS Says Providers Are Gaming Billing Dispute System
Blue Cross Blue Shield of Georgia has accused a healthcare consulting firm and a handful of Peach State providers of systematic abuse of a federal dispute resolution process for surprise medical bills, accusing them of "flooding" the system with bogus dispute claims.
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May 29, 2025
Express Scripts Says Arkansas Can't Ban PBM Pharmacies
Pharmacy benefits manager Express Scripts sued the state of Arkansas in federal court Thursday, alleging that the state's recently enacted law banning PBMs from owning pharmacies in the state violated the U.S. Constitution and ran afoul of federal law governing military employee benefits.
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May 29, 2025
Split 9th Circ. Says Spa's Rule On Certain Trans Women Biased
A divided Ninth Circuit refused to reinstate a Korean spa's constitutional challenge against the Washington State Human Rights Commission and ordered it to rescind its policy denying admission to trans women without gender-affirming surgery, noting Thursday the policy violated state law prohibiting discrimination based on sexual orientation and gender identity.
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May 28, 2025
Elon Musk Is Leaving White House Role, Trump Admin Says
Billionaire Elon Musk is ending his work with President Donald Trump and the federal Department of Government Efficiency, a White House official confirmed Wednesday evening.
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May 28, 2025
Justices Told Del. Expert Law Doesn't Apply In Federal Court
A retired attorney who claims he was negligently injured by healthcare providers urged the U.S. Supreme Court on Tuesday to hold that a Delaware federal court need not apply a state statute requiring an expert affidavit for all medical malpractice suits.
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May 28, 2025
Judge Rejects Johns Hopkins Unit's Claim FCA Suit Is Untimely
A Maine federal judge on Wednesday denied Johns Hopkins Medical Services Corp.'s bid to dismiss a False Claims Act suit as untimely, ruling it must face allegations it failed to report being overpaid for healthcare services for military personnel, retirees and their families.
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May 28, 2025
Feds Urge Supreme Court To Let 10th Circ. PBM Ruling Stand
The federal government urged the U.S. Supreme Court not to take up the state of Oklahoma's challenge to a Tenth Circuit decision that found parts of a law regulating pharmacy benefit managers were preempted by federal benefits and healthcare laws, arguing the case doesn't warrant further review from the justices.
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May 28, 2025
Colorado, Feds Clash Over $6.7M From Collapsed Insurer
A Colorado federal judge pressed the state Wednesday on how its bid to pay out $6.7 million from a defunct health insurer to a Denver Health plan doesn't conflict with the federal government's interests, noting the disbursement would result in less money to a federal risk program.
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May 28, 2025
DOJ Says Justices' Ruling Backs Nursing Exec's Conviction
The U.S. Department of Justice is pointing to a recent U.S. Supreme Court ruling to bolster its fight against a new trial being sought by a convicted Nevada nursing home executive, saying that the new high court decision establishes that economic loss isn't needed to prove wire fraud.
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May 28, 2025
Cooley Adds Ex-FDA Attorney To DC Life Sciences Group
Cooley LLP has hired a former U.S. Food and Drug Administration attorney, who for the majority of her public service career worked as an associate chief counsel, trying civil actions and criminal prosecutions against those accused of violating regulations for a range of products.
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May 27, 2025
Musk, DOGE Fail To Nix States' Suit Against 'Limitless' Power
Fourteen states can proceed in their lawsuit challenging Elon Musk and the Department of Government Efficiency's influence in the federal government after a D.C. federal judge Tuesday refused to toss their suit, rejecting the government's contention that Musk wasn't subject to the U.S. Constitution's appointments clause.
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May 27, 2025
CMS Heightens Medicaid Oversight For Immigrant Care
The Centers for Medicare & Medicaid Services on Tuesday said it is ramping up its financial oversight of states to detect misuse of federal Medicaid dollars, telling states it will seek to recoup federal funds spent on nonemergent care for "illegal aliens."
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May 27, 2025
Healthcare Hires: Wilson Sonsini, BCLP, Proskauer And More
Wilson Sonsini Goodrich & Rosati PC has bolstered its regulatory practice with the addition of a U.S. Department of Health and Human Services attorney who most recently led Crowell & Moring LLP's digital health group.
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May 27, 2025
What The MAHA Report Tells Us About Its Future Agenda
A long-awaited report from a commission tasked with addressing childhood chronic disease in the United States signals key parts of the healthcare system that may soon see policy changes as part of the larger Make America Healthy Again agenda.
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May 27, 2025
The Surgical Pay Gap: How Bias May Hurt Women's Health
Medical and legal professionals warn that systemic sex discrimination in U.S. surgical valuations — in the form of lower pay for procedures on female anatomy — discourages specialization in women's health, leads to delayed care and increased suffering for female patients, and could expose insurers to legal liability.
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May 27, 2025
Feds No Longer Advise COVID Shot For Kids, Pregnant Adults
The nation's public health agency on Tuesday pulled the COVID-19 vaccine from the list of recommended shots for healthy children and pregnant adults, a move that experts say could reduce demand for the vaccine and make it more expensive for some families.
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May 27, 2025
Fla. Judge Pauses Suit Over Baseball Player's Death
A Florida state court judge on Tuesday ordered a temporary halt to a lawsuit alleging medical malpractive against a Minnesota Twins physician over the death of a minor league baseball player, pausing the case while an order denying immunity for the doctor is appealed.
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May 27, 2025
Wilson Sonsini Adds Ex-HHS, Crowell & Moring Leader In DC
A former policy director at the U.S. Department of Health and Human Services who later helped Crowell & Moring LLP launch its healthcare consulting group has joined Wilson Sonsini Goodrich & Rosati PC's Washington, D.C., team, the firm announced Tuesday.
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May 23, 2025
Minn. Patient Sues Over Colorado Limits On Aid-In-Dying Care
A new suit by two Colorado doctors and an out-of-state patient challenges a state restriction barring nonresidents from accessing a form of healthcare legalized in Colorado allowing patients to receive a doctor's help in ending their life.
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May 23, 2025
Ex-McKinsey Exec Sentenced For Obstructing Purdue Probe
A Virginia federal judge has sentenced a disbarred attorney and former McKinsey & Co. partner to six months in prison for obstructing an investigation into the consulting giant's work with opioid manufacturer Purdue, federal prosecutors announced Friday.
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May 23, 2025
Trump Admin Must Restore 'Censored' Harvard Docs' Articles
A Massachusetts federal judge on Friday ordered the U.S. Department of Health and Human Services to restore articles penned by two Harvard Medical School researchers that contained terms like "transgender" and "LGBTQ," calling their removal a "textbook example of viewpoint discrimination."
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May 23, 2025
Class Of Health Plans Certified In Avandia Marketing MDL
A Pennsylvania federal judge has certified a class of health plans in multidistrict litigation over GlaxoSmithKline's alleged deceptive marketing of the drug Avandia in which the plans claim they wouldn't have paid higher premiums for the drug if they'd known about its potential cardiovascular risks.
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May 22, 2025
Clinic Tells NC Justices Med Mal Reforms Apply To Practices
An orthopedic clinic is urging North Carolina's highest court to free it from a family's negligent-retention claim over an allegedly faulty surgery by a doctor who later lost his license, asserting that the lower court incorrectly found that state medical malpractice statutes and subsequent reforms don't apply to medical practices.
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May 22, 2025
Justices Urged To Undo Denial Of Fast Track For Gastro Drug
Vanda Pharmaceuticals Inc. is asking the U.S. Supreme Court to reverse the Food and Drug Administration's decision denying fast-track approval for its gastroparesis drug tradipitant, saying it meets the statutory standard for fast-track review as a new treatment with the "potential to address unmet medical needs."
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May 22, 2025
Judge Asks If DEI Is Now 'Homogeneity, Inequity And Exclusion'
A Massachusetts federal judge considering a challenge to the Trump administration's cuts to hundreds of National Institutes of Health grants pressed the U.S. Department of Justice on Thursday for its definition of diversity, equity and inclusion, at one point asking hypothetically whether the government's policy is now "homogeneity, inequity and exclusion."
Expert Analysis
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Calif. Banking Brief: All The Notable Legal Updates In Q2
The second quarter of 2024 in California, which saw efforts to expand consumer protection legislation and enforcement actions in areas of federal focus like medical debt and student loans, demonstrated that the state's role as a trendsetter in consumer financial protection will continue for the foreseeable future, say attorneys at Sheppard Mullin.
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How Cannabis Rescheduling May Affect Current Operators
The U.S. Drug Enforcement Agency's proposal to reschedule marijuana to Schedule III provides relief in the form of federal policy from the stigma and burdens of Schedule I, but commercial cannabis operations will remain unchanged until the federal-state cannabis policy gap is remedied by Congress, say Meital Manzuri and Alexis Lazzeri at Manzuri Law.
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Air Ambulance Ruling Severely Undermines No Surprises Act
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.
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Class Actions At The Circuit Courts: June Lessons
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.
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How Congress Is Tackling The US Healthcare Shortage
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.
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The Current State Of Healthcare Transaction Reviews In Calif.
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.
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High Court's Abortion Pill Ruling Shuts Out Future Challenges
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.
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Orange Book Warnings Highlight FTC's Drug Price Focus
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.
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A Plaintiffs-Side Approach To Cochlear Implant Cases
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.
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Inside Antitrust Agencies' Rollup And Serial Acquisition Moves
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.
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Short-Term Takeaways From CMS' New Long-Term Care Rules
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.
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FDA's Data Monitoring Guidance Reveals Future Expectations
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.
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FDA Warning Indicates Scrutiny Of Regenerative Health Cos.
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.