Policy & Compliance
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May 05, 2025
Fed. Circ. Affirms Coverage Denial Over Pre-Service Surgery
A lower court did not err when it upheld the denial of a Navy veteran's shoulder disability claim based on a surgery that he had before entering the service, a Federal Circuit panel ruled.
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May 05, 2025
Kaiser Permanente Escapes 401(k) Forfeiture Suit, For Now
A California federal judge tossed a proposed class action alleging Kaiser Permanente misspent forfeitures from an employee 401(k) plan, concluding the allegations failed to state a claim for a violation of federal benefits law.
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May 05, 2025
Novartis, Incyte Settle Drug Royalty Fight On Eve Of Trial
A Manhattan federal judge put off trial on Monday in a five-year quest by Novartis to recover what it says are $500 million in missing royalties from its agreement to commercialize an Incyte compound used to treat blood cancers, with the sides announcing they reached a settlement.
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May 02, 2025
Fla. Lawmakers Vote To Repeal Law That Limits Death Suits
Florida lawmakers have voted to do away with a statute that plaintiffs attorneys say unfairly and arbitrarily limits pain-and-suffering damages in fatal medical malpractice cases, but an attorney representing healthcare providers says that repealing the law will cause a flood of new lawsuits.
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May 02, 2025
Ill. Judge Questions Legal Theory In Multiplan Pricing MDL
An Illinois federal judge handling multidistrict litigation accusing Multiplan of conspiring with insurers to fix out-of-network reimbursement rates seemed unsure Friday that a viable antitrust theory is at play, saying the plaintiffs' alleged market dynamic seems similar to various individuals independently deciding to hire the same "really good painter."
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May 02, 2025
Boston Scientific, FDA Sued Over 'Unsafe' Spinal Implant
Boston Scientific evaded safety regulations to market a defective spinal cord stimulator and the U.S. Food and Drug Administration rubber-stamped those alterations in an instance of "agency capture," according to a California federal lawsuit filed by a patient suffering from ongoing pain after the device was implanted.
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May 01, 2025
Planned Parenthood Slams HHS 'Attacks' On Teen Program
Planned Parenthood on Thursday pressed a D.C. federal court to block the U.S. Department of Health and Human Services' "attacks" on a long-running, successful public health initiative aimed at preventing teen pregnancy, claiming that HHS has implemented new, "deeply inconsistent" requirements threatening the program's funding.
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May 01, 2025
Aetna And Humana Accused Of Medicare Kickbacks And Bias
The federal government brought a bombshell False Claims Act suit Thursday against Aetna, Elevance and Humana, claiming the insurers paid hundreds of millions of dollars in illegal kickbacks to brokers in exchange for enrollments into their Medicare Advantage plans, with Humana and Aetna also accused of discriminating against disabled beneficiaries.
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May 01, 2025
HHS Report Finds 'Serious Concerns' On Trans Care For Youth
The U.S. Department of Health and Human Services on Thursday released a report it says raises "serious concerns" about medical interventions used to aid young people in gender transition.
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May 01, 2025
Couple's J&J Pelvic Mesh Claims Too Late, 11th Circ. Affirms
The Eleventh Circuit held Thursday that a couple's lawsuit against Johnson & Johnson over injuries allegedly caused by a pelvic mesh device made by the company's med-tech unit was filed too late despite evidence that the woman's doctors had expressed uncertainty for years about whether the mesh was causing her pain.
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May 01, 2025
Publix Can't Slip 'Zero-Market Share' Opioid Claims
Publix Super Markets Inc. can't slip opioid-related claims from nine municipalities in which the supermarket chain alleges it has no pharmacies, an Ohio federal judge overseeing sprawling national opioid litigation ruled.
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May 01, 2025
CFPB, Lenders Float Deal To Vacate Medical Debt Rule
The Consumer Financial Protection Bureau has agreed to a proposed consent judgment that would vacate a Biden-era rule banning an estimated $49 billion in medical debt from credit reports, striking a deal with lender trade groups that sued in Texas federal court to block the rule.
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May 01, 2025
PBMs Tell 6th Circ. Ohio's Pricing Case Belongs In Fed Court
Express Scripts and Prime Therapeutics urged the Sixth Circuit to undo a district court order returning a lawsuit from Ohio's attorney general alleging they drove up prescription drug prices to state court, arguing Wednesday an after-the-fact disclaimer of federal program-based claims isn't enough to sever a federal law connection.
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May 01, 2025
J&J Talc Unit Says New Doc 'Key' To Talc Study Libel Suit
A Johnson & Johnson talc unit has asked a New Jersey federal court to reinstate its libel suit over a scientific article linking talcum powder to mesothelioma, arguing that newly discovered evidence shows statements in the article are false.
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May 01, 2025
Payment Math Dooms Sandoz Price-Fixing Deal With Florida
A Connecticut federal judge on Thursday refused to put a bow on the deal the state of Florida struck with Sandoz AG and related defendants in three generic drug price-fixing lawsuits, ruling from the bench in Hartford that the settlement agreement "as written" would lead to exorbitant supplemental payments in the event that other states also reach deals to release their claims.
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May 01, 2025
Ex-Conn. State Employee Cops To $1.8M Medicaid Scam Role
A former Connecticut government employee admitted to playing a part in a $1.8 million scheme to defraud the Constitution State's Medicaid program by fraudulently billing services for children with autism that her company never provided, acting U.S. Attorney Marc H. Silverman has announced.
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May 01, 2025
Rehab Center To Pay $19.75M To Resolve FCA Case
A New Jersey drug and alcohol rehabilitation center will pay $19.75 million to resolve claims that it violated the False Claims Act by concealing it had no license from state regulators and billed the Veterans Health Administration and Medicaid for its services.
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April 30, 2025
DOJ Urges 11th Circ. To Restore FCA Whistleblower Provision
The U.S. Department of Justice told the 11th Circuit on Wednesday that a Florida federal judge was wrong to rule that the provision of the False Claims Act that lets whistleblowers bring suits on the government's behalf was unconstitutional, arguing that the judge erred in saying whistleblowers were an unappointed part of the federal workforce.
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April 30, 2025
SuperValu Fights New Trial Bid In Whistleblower Drug Case
SuperValu urged an Illinois federal judge Tuesday not to overturn its defense win on whistleblower claims of systematic prescription overbilling, saying the whistleblowers are now making "kitchen sink arguments" with little basis.
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April 30, 2025
Atlanta Home Health Service Faces Overtime Class Action
An Atlanta home healthcare service was hit with a proposed class action Wednesday over allegations it failed to pay certified nursing assistants proper overtime compensation.
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April 30, 2025
DOL, HHS Seek Nix Of Bid To Halt DOGE's Access To Systems
The U.S. Department of Labor and the U.S. Department of Health and Human Services challenged a bid to halt agencies from giving Elon Musk's Department of Government Efficiency access to sensitive systems, telling a D.C. federal judge that a group of unions didn't show personal information would be leaked.
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April 30, 2025
Kratom Cos. Get False Ad, Addiction Suit Tossed
A California federal judge has dismissed a proposed class action alleging Thang Botanicals and FTLS Holdings LLC mislead consumers about addictive qualities of their kratom products after the plaintiffs failed to file an amended complaint on time.
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April 29, 2025
Gilead Will Pay $202M In DOJ Deal Over Drug Kickbacks
Gilead agreed to pay $202 million to the federal government and some states to resolve claims it made improper payments to high-volume prescribers of its HIV drugs, New York federal prosecutors announced Tuesday.
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April 29, 2025
Omnicare Hit With $136M Jury Verdict For Bilking Feds
A New York federal jury on Tuesday returned a verdict finding that CVS Health Corp. subsidiary Omnicare illegally billed the federal government to the tune of $135.6 million, one of the largest jury verdicts in a False Claims Act case, according to a statement from the U.S. Department of Justice.
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April 29, 2025
Ohio Justices Reinstate Trans Care Limits During AG's Appeal
The Ohio Supreme Court on Tuesday reinstated state law limits on gender-affirming care for transgender youths pending Ohio Attorney General Dave Yost's appeal of what he called "radical constitutional views" of an Ohio state appeals court that last month blocked the restrictions.
Expert Analysis
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What To Expect For Stem Cell Regulation Under Trump Admin
The new administration's push for deregulation, plus the post-Chevron legal landscape, and momentum from key political and industry players to facilitate stem cell innovation may create an opportune backdrop for a significant reduction in the U.S. Food and Drug Administration's regulatory framework for stem cells, say attorneys at Sheppard Mullin.
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How Importers Can Minimize FCA Risks Of Tariff Mitigation
False Claims Act risks are inherent in many tariff mitigation strategies, making it important for importers to implement best practices to identify and report potential violations of import regulations before they escalate, says Samuel Finkelstein at LMD Trade Law.
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10 Practical Takeaways From FDA's Biopharma AI Guidance
Recent guidance from the U.S. Food and Drug Administration provides much-needed insight on the usage of artificial intelligence in producing information to support regulatory decision-making regarding drug safety, with implications ranging from life cycle maintenance to AI tool acquisition, say attorneys at Covington.
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Lawmakers Shouldn't Overlook Rare Disease Therapies' Value
As the ORPHAN Cures Act is pending in Congress, policymakers assessing the value of certain drugs for price regulation should consider data beyond what is collected in clinical trials, say Alice Chen at the University of Southern California, and Molly Frean and Yao Lu at Analysis Group.
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What Trump's Order Means For The Legal Status Of IVF
An executive order signed by President Donald Trump last month signals the administration's potential intention to increase protections for in vitro fertilization services, though more concrete actions would be needed to resolve the current uncertainty around IVF access or bring about a binding legal change, says Jeanne Vance at Weintraub Tobin.
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Mitigating Tariff Risks For Healthcare In US And Canada
Healthcare stakeholders should take steps to evaluate the impact of cross-border tariffs, as the historically strong ties between Canada and the U.S. demonstrate the potential for real disruption and harm to the healthcare industry in both countries, say attorneys at Norton Rose.
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What's At Stake In High Court Transgender Care Suit
The outcome of U.S. v. Skrmetti will have critical implications for the rights of transgender youth and their access to gender-affirming care, and will likely affect other areas of law and policy involving transgender individuals, including education, employment, healthcare and civil rights, say attorneys at ArentFox Schiff.
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6 Laws Transforming Calif.'s Health Regulatory Framework
Attorneys at Hooper Lundy discuss a number of new California laws that raise pressing issues for independent physicians and small practice groups, ranging from the use of artificial intelligence to wage standards for healthcare employees.
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Anticipating Calif. Oversight Of PE Participation In Healthcare
A new bill recently introduced in the California Senate revives last year's attempt to increase oversight of healthcare transactions involving private equity groups and hedge funds, meaning that attorneys may soon need to assess the compliance status of existing management relationships and consider modifying contract terms, says Andrew Demetriou at Husch Blackwell.
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Considering The Future Of AI Regulation On Health Sector
As Texas looks to become the next state to pass a comprehensive law regulating artificial intelligence, the healthcare industry should consider how AI regulation will continue to evolve in the U.S. and how industry members can keep up with compliance considerations, say attorneys at Kirkland & Ellis.
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What To Expect From 'Make America Healthy Again' Actions
The Make America Healthy Again Commission recently established by President Donald Trump and chaired by Robert F. Kennedy Jr. will potentially bring energy and attention to important public health topics, and stakeholders should be aware of pathways for sharing their input and proactively informing proceedings, says Nicholas Manetto at Faegre Drinker.
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How Citizen Petitions Have Affected Drug Competition
In light of recent citizen petitions and proposed legislation regulating such petitions, Omar Robles at Managing Health analyzes the statistics of the extent to which citizen petitions have been filed, and to what extent they have delayed competition in prescription pharmaceuticals.
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Drug Kickback Ruling Will Make FCA Liability Harder To Prove
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.