Policy & Compliance

  • July 29, 2025

    Ark. Law Banning PBM-Owned Pharmacies Put On Ice

    Arkansas can't enforce a law banning pharmacy benefit managers from owning pharmacies in the state, a federal judge ruled, saying that CVS, Express Scripts, Optum and a trade group are likely to succeed on their claims that the statute unlawfully restricts interstate commerce.

  • July 29, 2025

    9th Circ. Clarifies Kickback Boundaries For Referral Bonuses

    A Ninth Circuit opinion affirming a California man's fraud conviction provides some clarity — and a warning — to the owners of medical testing laboratories wondering what sales tactics are allowed under a 2018 kickbacks law.

  • July 29, 2025

    Meet Josh Craddock, Fetal Personhood Advocate Joining DOJ

    President Donald Trump has named a former BigLaw attorney and outspoken proponent of the fetal personhood legal doctrine to serve as deputy assistant attorney general at the legal arm of the U.S. Department of Justice.

  • July 28, 2025

    PBMs Can't Escape NY State Law Claims In Opioid MDL

    Two UnitedHealth subsidiaries cannot escape claims that they exacerbated the opioid crisis by providing data analytics and consulting services to drugmakers, a federal judge overseeing the multidistrict litigation ruled on Monday, saying the New York state municipalities have adequately alleged RICO by claiming they were part of the same criminal conspiracy.

  • July 28, 2025

    Express Scripts, Prime Urge Court To Toss Mich. Price-Fix Suit

    Two pharmacy benefit managers sought to shake allegations of price-fixing brought by Michigan Attorney General Dana Nessel, arguing Friday that her antitrust suit suffers from several fatal legal flaws, including that the state does not have standing to sue on pharmacies' behalf.

  • July 28, 2025

    DOJ Probes NewYork-Presbyterian Over Antitrust Allegations

    The U.S. Department of Justice has opened an investigation into NewYork-Presbyterian Healthcare System for allegedly violating antitrust laws by cutting deals with insurance companies that have led to rising healthcare costs, according to a subpoena viewed by Law360.

  • July 28, 2025

    Judge Again Cites Bias In NIH Fund Freeze As Gov't Appeals

    A Massachusetts federal judge on Monday reiterated his conclusion that the Trump administration's freeze of $783 million worth of National Institutes of Health grants was based on "palpable" gender and racial discrimination, as he acknowledged a pending request by the government to the U.S. Supreme Court to stay his order that the money be released.

  • July 28, 2025

    Judge Says Trump Admin Can't Defund Planned Parenthood

    A Massachusetts federal judge on Monday blocked President Donald Trump's administration from denying Medicaid reimbursements to Planned Parenthood clinics, expanding an earlier ruling that had applied only to those that do not provide abortions or that receive minimal federal support.

  • July 25, 2025

    Utah Docs Say Billing Expert's Report Rife With AI Falsehoods

    Utah anesthesiologists facing a False Claims Act suit are moving to bar the testimony of a medical billing expert they say used artificial intelligence to draft a report riddled with errors and fake citations, calling it an extraordinary example of AI gone wrong.

  • July 25, 2025

    Hospital Giant To Pay $3.5M Over Nurse Training Repayments

    HCA Healthcare Inc., a major U.S. hospital operator, has agreed to pay roughly $3.5 million to settle claims that it unlawfully trapped new nurses in agreements requiring them to repay training costs if they left their jobs within two years, according to a trio of state attorneys general.

  • July 25, 2025

    Health Data Co. Investor Fraud Suit Headed To Mediation

    The parties in a putative class action claiming a healthcare technology company misled investors about a data platform it claimed to operate, but which didn't actually exist, told a Connecticut federal court that they "agree this case is well suited for mediation."

  • July 24, 2025

    Trump Admin Asks Justices To Stay Block On NIH Grant Cuts

    The Trump administration on Thursday urged the U.S. Supreme Court to stay a district court's preliminary injunction so that the National Institutes of Health can resume terminating $783 million in grants, saying the lower court, under a recent high court ruling, lacked jurisdiction to make the government pay the grants.

  • July 24, 2025

    Hospital Must Face Claims Of Mismanaging Retirement Funds

    A Colorado federal judge on Thursday said a proposed class action will continue against a hospital over allegations of mismanaging employees' retirement funds after an amended complaint added new allegations about the fund's mismanagement.

  • July 24, 2025

    UnitedHealth Discloses DOJ Medicare Civil, Criminal Probes

    UnitedHealth Group Inc. has disclosed that it is complying with formal criminal and civil requests from the U.S. Department of Justice, following media reports about investigations into aspects of the insurance giant's participation in Medicare.

  • July 24, 2025

    3rd Circ. Rules Philly Injection Site Equals Religious 'Person'

    A nonprofit battling government resistance to its planned safe drug injection site in Philadelphia can qualify for religious freedom protections, the Third Circuit said in a precedential opinion on Thursday, reasoning the organization meets the definition of a "person" practicing religion.

  • July 23, 2025

    FTC Wants PE Firm's Medical Device Coating Deal Put On Ice

    Private equity firm GTCR BC Holdings' $627 million merger with Surmodics will bring the previously fierce competition for medical device coatings to a grinding halt, the FTC says, which is all the more reason a federal court should block the deal while an agency challenge plays out.

  • July 23, 2025

    Symbria Workers' $5.9M ESOP Deal Gets Ill. Judge's Final OK

    An Illinois federal judge gave his final blessing Tuesday to a $5.9 million settlement between Argent Trust Co. and a group of Symbria Inc. employees who accused the company of mismanaging their employee stock ownership plan.

  • July 23, 2025

    Bird Marella And Bioscience Client Accused Of $87M Fraud

    An investment group that includes a "Toy Story" screenwriter is suing a Culver City, California-headquartered bioscience company and its Bird Marella attorneys in California state court, accusing them of manipulating the valuation of a company whose acquisition they funded, in order to defraud investors of $87 million.

  • July 23, 2025

    Co., Lenders Hit With Suit Over Medical Spa Financing Scam

    A medical device manufacturer and several financing companies worked together to manipulate boutique clinics and medical spas into purchasing expensive cosmetic devices based on inflated revenue projections and false promises of marketing support, according to a proposed class action filed Monday in California federal court.

  • July 22, 2025

    FCA Draws Heavy Constitutional Fire After $1.6B J&J Verdict

    Reeling from a record fraud verdict tied to drug promotion practices, Johnson & Johnson is pursuing a sweeping constitutional challenge to the False Claims Act, and in filings this week at the Third Circuit, major industry allies rallied behind its views of whistleblower litigants usurping executive branch power.

  • July 22, 2025

    Healthcare In Court: NIH Grant Cuts, Flo Health Trial And More

    A First Circuit panel refused to hit pause on a Massachusetts federal judge's order voiding cuts by the National Institutes of Health to hundreds of grant programs. Meanwhile, in California, a jury trial kicked off over allegations of unlawful information sharing between menstrual app developer Flo Health Inc. and Meta Platforms. 

  • July 22, 2025

    Sandoz Loses 'Nonsense' Bid To Avoid DOJ Deal In AGs' Case

    A Connecticut federal judge has given dozens of state attorneys general a small but important win in a sprawling price-fixing litigation against generic-drug makers, applying previous admissions of criminal wrongdoing and flatly rejecting "ridiculous" efforts by Sandoz, Taro Pharmaceuticals and a former Sandoz official to avoid that application.

  • July 22, 2025

    Ohio Justices Accept AG's Bid To Limit Care For Trans Youths

    The Ohio Supreme Court on Tuesday agreed to review an appeals court's finding that portions of a state law restricting gender-affirming care for transgender youths are unconstitutional. 

  • July 22, 2025

    Employers, Plans Force Freeze Of Iowa's PBM Law

    A federal judge slapped a temporary hold on parts of an Iowa law that aims to limit pharmacy benefit managers' power to set drug prices, ruling that provisions barring discrimination against certain pharmacies and pushing cost-saving strategies are preempted by federal benefits law.

  • July 22, 2025

    4th Circ. Backs Medicaid Fraud Conviction, 17-Year Sentence

    A North Carolina lab owner lost his bid Tuesday to overturn his healthcare fraud conviction after the Fourth Circuit found evidence against him to be sufficient and the terms of his sentence reasonable.

Expert Analysis

  • Reproductive Health Under Trump So Far, And What's Next

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    Based on priorities stated so far, the Trump administration will likely continue to weaken Biden-era policies that protect reproductive health, with abortion, in vitro fertilization and contraception all being issues to watch closely amid a post-Dobbs shift, say attorneys at McDermott.

  • What's Next For Lab Test Regulation Without FDA Authority

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    A recent Texas federal court decision vacating the U.S. Food and Drug Administration's final rule that would apply FDA regulations to laboratory-developed tests signals potential positive impacts in the diagnostic space, and could inspire more healthcare entities to litigate against the government, say attorneys at Hooper Lundy.

  • 6 Criteria Can Help Assess Executive Branch Actions

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    With new executive policy changes announced seemingly every day, several questions can help courts, policymakers and businesses determine whether such actions are proper, effective and in keeping with our democratic norms, say Marc Levin and Khalil Cumberbatch at the Council on Criminal Justice.

  • Learning From COVID-19 Enforcement Against Nursing Homes

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    Five years after the COVID-19 outbreak caused a high number of deaths in nursing homes, an examination of enforcement actions against nursing homes in New York and elsewhere in the country highlights obstacles that may arise when bringing cases of this type, and ways to overcome them, says Kenneth Levine at Stone & Magnanini.

  • How Plan Sponsors Can Mitigate Risk In PBM Contracts

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    A recent lawsuit in New York federal court alleges that JPMorgan caused exorbitant prescription costs by mishandling the pharmacy benefit manager arrangement, adding to a growing body of Employee Retirement Income Security Act fiduciary breach litigation and affirming that fiduciaries must proactively manage their healthcare plan vendors, say attorneys at Hall Benefits Law.

  • 4th Circ. Health Data Ruling Opens Door To State Law Claims

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    In Real Time Medical v. PointClickCare, the Fourth Circuit recently clarified that state law claims can rest in part on violations of a federal law that prohibits electronic health information blocking, expanding legal risks for health IT companies and potentially creating exposure to a range of competitive implications, say attorneys at BCLP.

  • Unpacking Trump Admin Plans For Value-Based Care

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    Recent developments from the Center for Medicare and Medicaid Innovation suggest the Trump administration intends to put its own stamp on value-based care, emphasizing cost savings assessment in particular, with its recent cancellation of several payment models that had supported primary care, says Miranda Franco at Holland & Knight.

  • What To Expect For Stem Cell Regulation Under Trump Admin

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    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.

  • How Importers Can Minimize FCA Risks Of Tariff Mitigation

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    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.

  • 10 Practical Takeaways From FDA's Biopharma AI Guidance

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    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.

  • Lawmakers Shouldn't Overlook Rare Disease Therapies' Value

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    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.

  • What Trump's Order Means For The Legal Status Of IVF

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    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.

  • Mitigating Tariff Risks For Healthcare In US And Canada

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    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.