Policy & Compliance
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May 05, 2025
DC Circ. Has Doubts About Narcolepsy Drug Appeal
The D.C. Circuit is now set to decide whether the U.S. Food and Drug Administration was wrong to declare a rival narcolepsy treatment not the "same drug" as another produced by Jazz Pharmaceuticals Inc., after appearing highly skeptical of the drug company's arguments that it was.
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May 05, 2025
High Court Urged To Back HHS Authority On Preventive Care
The federal government urged the U.S. Supreme Court on Monday to overturn a Fifth Circuit ruling that found the U.S. Department of Health and Human Services' secretary lacked authority over a preventive healthcare services task force, arguing the HHS secretary's oversight stemmed from multiple laws and precedent.
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May 05, 2025
UnitedHealth Tells Court Not To Review Special Master Report
A special master rightly determined that no reasonable jury could render a verdict for the U.S. Department of Justice in a massive False Claims Act case targeting Medicare Advantage plans operated by UnitedHealth, the health insurance company told a D.C. federal judge.
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May 05, 2025
Trump Admin Urges Dismissal Of States' Abortion Pill Suit
The Trump administration on Monday asked a Texas federal judge to dismiss a lawsuit seeking to roll back access to the abortion medication mifepristone, contending the three states pursuing the case waited too long to file and are suing in the wrong jurisdiction.
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May 05, 2025
Wash. Panel Quizzes State In Biologist's Vax Mandate Case
Washington appellate judges hinted on Monday they might revive an ex-state biologist's suit claiming she was wrongfully denied a religious accommodation to keep her position without getting the COVID-19 vaccination, citing factual questions as to whether her job duties were essential and whether she was technically fired.
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May 05, 2025
Fla. Judge Wants Briefs In ACA Trans Health Fight
A Florida federal judge Monday requested briefing from the U.S. Department of Health and Human Services and the state of Florida on how to handle a suit challenging the Biden administration's regulations clarifying gender identity-based discrimination under the Affordable Care Act.
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May 05, 2025
20 AGs Sue To Stop 'Illegal Dismantling' Of HHS
Twenty attorneys general sued the Trump administration Monday in Rhode Island federal court alleging that massive cuts to the U.S. Department of Health and Human Services violate the Constitution and usurp congressional authority.
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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.
Expert Analysis
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Patent Waiver For COVID Meds Would Harm US Biopharma
If the Biden administration backs the World Trade Organization in waiving patent rights on COVID-19 treatments, it would negatively affect the U.S. biopharmaceutical industry and help foreign competitors, without necessarily expanding global access to COVID-19 care, says clinical pathologist Wolfgang Klietmann.
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New CMS Rule Will Change Nursing Facility Disclosures
A new rule from the Centers for Medicare & Medicaid Services significantly expands disclosure requirements for nursing facilities backed by private equity companies or real estate investment trusts, likely foreshadowing increased oversight that could include more targeted audits, say Janice Davis and Christopher Ronne at Morgan Lewis.
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Skirting Anti-Kickback Causation Standard Amid Circuit Split
Amid the federal circuit court split over the causation standard applicable to False Claims Act cases involving Anti-Kickback Statute violations, which the First Circuit will soon consider in U.S. v. Regeneron, litigators aiming to circumvent the heightened standard should contemplate certain strategies, say Matthew Modafferi and Terence Park at Frier Levitt.
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Gilead Ruling Signals That Innovating Can Lead To Liability
A California appeals court's ruling last month in Gilead Life Sciences v. Superior Court of San Francisco that a drug manufacturer can be held liable for delaying the introduction of an improved version of its medication raises concerns about the chilling effects that expansive product liability claims may have on innovation, says Gary Myers at the University of Missouri School of Law.
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Health Policy Legislative Landscape May Remain Frozen
With Congress again delaying the full resolution of fiscal year 2024 federal spending legislation, there is now an additional window in which Congress could work through several priority issues for healthcare stakeholders, though these issues are unlikely to be resolved in time, say attorneys at Faegre Drinker.
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Despite HHS Opinion, Gift Card Giveaways Require Caution
Though the U.S. Department of Health and Human Services' Office of Inspector General recently determined that a healthcare consulting firm's gift card plans do not violate the Anti-Kickback Statute, the opinion does not suggest blanket approval for providing gift cards in exchange for referrals, say Ragini Acharya and Matthew Deutsch at Husch Blackwell.
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DOJ's Biopharma Settlement Raises Anti-Kickback Questions
In the aftermath of the U.S. Department of Justice's settlement with Ultragenyx over genetic testing programs, it may be prudent to reevaluate genetic tests through the lens of the Anti-Kickback Statute and reconsider whether it is proper for free testing programs to be treated like patient assistance programs, says Mary Kohler at Kohler Health Law.
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Where Justices Stand On Chevron Doctrine Post-Argument
Following recent oral argument at the U.S. Supreme Court, at least four justices appear to be in favor of overturning the long-standing Chevron deference, and three justices seem ready to uphold it, which means the ultimate decision may rest on Chief Justice John Roberts' vote, say Wayne D'Angelo and Zachary Lee at Kelley Drye.
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Bracing For Calif.'s New Health Transaction Framework
As California's new cost and market impact review regulations' April 1 date for its updated notice and review process approaches, healthcare entities should ready themselves for dramatic changes to the state's regulatory landscape and prepare for potentially substantial transaction delays, say Jordan Grushkin and Matthew Goldman at Sheppard Mullin.
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Uncharted Waters Ahead For FCA Litigation In 2024
Following a year of significant court decisions, settlements, recoveries and proposed amendments, 2024 promises to be a lively year for False Claims Act actions and litigation, and one that will hopefully provide more clarity as FCA jurisprudence evolves, say attorneys at Crowell & Moring.
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OIG Report Has Clues For 2024 Healthcare Fraud Enforcement
A recent report from the Health Department's Office of the Inspector General reveals healthcare fraud and abuse enforcement trends that will continue in 2024, from increased telehealth oversight to enhanced policing of managed care, say attorneys at Sheppard Mullin.
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FOIA Exemption Questions On Redacted HHS Cannabis Letter
The U.S. Department of Health and Human Services' recent recommendation letter concerning the rescheduling of cannabis was heavily redacted, and based on an analysis on the applicability of Freedom of Information Act Exemption 5 to the letter, it's likely that we will see successful legal challenges to those redactions, say attorneys at Troutman Pepper.
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A Primer On New Calif. Health Transaction Reporting Rules
New California regulations regarding the reporting of certain transactions involving healthcare entities, which took effect on Jan. 1, address some industry feedback about overly broad requirements but still leave several areas of concern, says Andrew Demetriou at Husch Blackwell.