Policy & Compliance
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April 15, 2025
Medicare Advantage 'Upcoding' In Federal Crosshairs
Dr. Mehmet Oz and others have called for a crackdown on fraud and waste in privately run Medicare plans. But addressing "upcoding" won't be easy, and healthcare attorneys are watching to see whether the increased attention translates into actual enforcement.
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April 15, 2025
Abortion Bans At Wyo. High Court: 3 Things To Know
Wyoming’s highest court is set to hear arguments over whether two near-total abortion bans violate the state Constitution and its guarantee of personal choice in healthcare.
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April 14, 2025
9th Circ. Says $24M Punitive Damages In Jail Death Too Steep
A jury correctly determined that a healthcare contractor was liable for the death of a woman in custody in a Washington jail, a split Ninth Circuit panel ruled Monday, but its $24 million award for punitive damages was excessive.
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April 14, 2025
Ark. PBM Regulation Violates ERISA, Teamsters Fund Says
An Arkansas insurance regulation forcing health plans to turn over information about reimbursement rates negotiated by pharmacy benefit managers, or PBMs, conflicts with federal benefits law, a Teamsters healthcare fund claimed, urging an Illinois federal court to block the state from enforcing the rule.
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April 14, 2025
Judge Threatens Penalties Over Late Report In Fla. Fee Suit
A Florida federal judge threatened parties in a federal proposed class action over excessive fees charged to maintain retirement savings plans, warning there will be sanctions if they do not respond to an order to show why they failed to timely file a case management report.
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April 14, 2025
Quinn Emanuel, King & Spalding Rep Harvard In Trump Letter
Harvard University on Monday turned to a pair of high-powered lawyers from Quinn Emanuel Urquhart & Sullivan LLP and King & Spalding LLP as the school pushed back on the Trump administration's policy demands linked to nearly $9 billion in federal funding — a move that prompted the government to freeze more than $2 billion in grants for the school.
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April 14, 2025
FTC Joins DOJ In Targeting Anticompetitive Regulations
The Federal Trade Commission launched a public inquiry Monday to look into reducing regulations that are hindering competition, following a similar move by the U.S. Department of Justice last month.
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April 14, 2025
Takeda Gets Actos Case Paused For Class Cert. Review
A New York federal court has paused a lawsuit accusing Takeda Pharmaceuticals of inflating the price of its diabetes treatment, Actos, by delaying the entry of generic alternatives, and took a scheduled July trial off the calendar, as the company appeals a class certification ruling.
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April 14, 2025
Healthcare Duo Joins Carlton Fields From Mass. Boutique
Carlton Fields announced Monday that a pair of experienced healthcare attorneys joined the firm's Los Angeles and Tampa, Florida, offices after a stint with Massachusetts boutique Kajko Weisman & Colasanti LLP.
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April 14, 2025
Sandoz Sues Amgen Over Enbrel Biosimilar
Sandoz accused Amgen of illegally blocking biosimilar competition to its blockbuster Enbrel drug for arthritis and other inflammatory diseases, alleging that the company used strategic acquisitions and illegal patent extensions to fend off challengers in the space and inflate U.S. prices for its drug.
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April 11, 2025
Amgen Can't Ditch Regeneron's Bundling Antitrust Suit
A Delaware federal judge on Thursday denied Amgen's bid to toss antitrust litigation brought by Regeneron accusing its rival of using a bundling scheme to increase the sales of its cholesterol drug Repatha and push competitors out of the market.
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April 11, 2025
Express Scripts Judge Asks If Khan's FTC Exit Affects Suit
The Missouri federal judge overseeing Express Scripts' lawsuit accusing the Federal Trade Commission of defaming it with a report excoriating the pharmacy benefits manager for allegedly inflating drug costs asked the parties Friday if new leadership at the commission affects the case that significantly targets former Chair Lina Khan.
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April 11, 2025
Telehealth Co. Sued Over 2024 Data Breach
A company that helps healthcare providers manage after-hours patient calls was hit with a proposed class action in New York federal court Friday alleging that it failed to secure user data prior to a 2024 breach that exposed the sensitive information of nearly 1 million people.
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April 11, 2025
Fla. Pharmacy Pleads Guilty To Fraud Over Opioid OD Drug
A Florida-based pharmacy has agreed to plead guilty to healthcare fraud and to pay more than $1 million to settle civil claims it submitted false authorizations for an expensive opioid overdose treatment to federal insurers.
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April 10, 2025
AbbVie Wants ND, SD Drug Pricing Laws Blocked
Drugmaker AbbVie Inc. on Thursday asked federal courts to block new drug-pricing laws in both North Dakota and South Dakota, alleging that the measures requiring the company to transfer products to certain pharmacies at discounted prices are unconstitutional.
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April 10, 2025
Vanda Sues FDA To Block Off-Label Use Drug Promo Regs
A pharmaceutical company, a Texas physician and an often-jet lagged traveler sued the U.S. Food and Drug Administration in Texas federal court Wednesday seeking to block marketing restrictions on the off-label uses of FDA-approved drugs, arguing that long-standing rules and Biden-era guidance runs afoul of the First Amendment.
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April 10, 2025
Calif. Centers Used 'Body Brokers' In $10M Scam, BCBS Says
Blue Cross Blue Shield of Oklahoma slammed two California recovery centers and their owners with a lawsuit Thursday, alleging they spearheaded a $10 million kickback scheme to employ "body brokers" to find Indigenous patients for substance treatment facilities where they went to appalling lengths to stop them from leaving.
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April 10, 2025
Holmes Seeks Full 9th Circ. Review Of Theranos Fraud Appeal
Convicted Theranos Inc. founder Elizabeth Holmes has asked the Ninth Circuit for en banc review of a panel's decision to affirm her criminal fraud conviction and 11-year prison sentence, saying problems with the opinion included a "time-warping relevance theory."
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April 10, 2025
Man Admits To $12.5M PPE Investment Fraud
A California man pled guilty Thursday to defrauding investors of $12.5 million by telling them he had a business opportunity to manufacture personal protective equipment and to create an aerosol product that would kill the coronavirus, Texas federal prosecutors said.
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April 10, 2025
Mich. Justices Mull Hospital's Liability For Contract Doc's Acts
The Michigan Supreme Court on Thursday weighed a Corewell Health hospital's possible vicarious liability for independent physicians practicing within the hospital, with one justice pushing back on the idea that liability would be limited to emergency rooms.
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April 09, 2025
Mass. Justices Asked To Raise Bar For Pension, Benefit Loss
Massachusetts' highest court was asked on Wednesday to adopt a more expansive interpretation of what constitutes cruel or unusual punishment or an excessive fine in the case of a former state trooper whose $1 million public pension and healthcare benefits were forfeited after his conviction in an overtime fraud case.
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April 09, 2025
2nd Circ. Allows Takeda To Appeal Actos Antitrust Class Cert.
A split Second Circuit will allow Takeda Pharmaceuticals Co. to immediately appeal a New York federal judge's ruling certifying two classes of direct purchasers and end payors in consolidated antitrust actions accusing the company of unlawfully inflating the price of its diabetes treatment Actos by delaying the entry of generic alternatives.
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April 09, 2025
Fertility Care Concerns Linger As PWFA Regs Face Revision
Efforts to pare down the U.S. Equal Employment Opportunity Commission's regulations requiring workplace accommodations for pregnancy-related conditions have centered largely on abortion, but experts warn that access to fertility treatment — which workers seek more frequently — may also become harder to get.
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April 09, 2025
Data Co. Can't Make DOL Accept Health Plan, Judge Says
A data-mining company can't force the U.S. Department of Labor to acknowledge that a health insurance plan offered in exchange for participants' user data is covered by federal benefits law, a Texas federal judge ruled, saying the case's thin record prevented the court from deciding issues the Fifth Circuit told it to consider.
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April 09, 2025
Religious Mission Justifies Philly Injection Site, 3rd Circ. Told
Counsel for a nonprofit seeking to open a safe injection site in Philadelphia told the Third Circuit Wednesday that it qualified as a religious organization immune from prosecution, despite not having any spiritual language in its incorporation documents.
Expert Analysis
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Nutraceutical Patent Insights As Market Heats Up
Companies entering the expanding nutraceutical market and seeking patents to protect their innovations should evaluate successful nutraceutical claim language and common patent challenges in this field, say attorneys at Sterne Kessler.
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How White Collar Attys Can Use Mythic Archetypes At Trial
A careful reading of a classic screenwriting guide shows that fairy tales and white collar trials actually have a lot in common, and defense attorneys would do well to tell a hero’s journey at trial, relying on universal character archetypes to connect with the jury, says Jack Sharman at Lightfoot Franklin.
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What 2024 Election Means For Drugs, Medicare And Medicaid
With Republicans running the White House, U.S. House of Representatives and U.S. Senate, the incoming administration is likely to provide pathways — through new initiatives and others returning from Trump's previous presidency — for a range of potential changes to drug pricing, Medicare and Medicaid, say attorneys at Morgan Lewis.
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Justices Mull Sex-Based Classification In Trans Law Case
After the U.S. Supreme Court heard oral argument in U.S. v. Skrmetti this week, it appears that the fate of the Tennessee law at the center of the case — a law banning gender-affirming healthcare for transgender adolescents — will hinge on whether the majority read the statute as imposing a sex-based classification, says Alexandra Crandall at Dickinson Wright.
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Key Takeaways From FDA's Latest Social Media Warnings
The U.S. Food and Drug Administration's latest untitled letter concerning a drug company's social media promotion provides lessons for how companies should navigate risk presentation, FDA labeling requirements and superiority claims, say attorneys at Sheppard Mullin.
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Rank-And-File DOJ Attorneys Will Keep Calm And Carry On
Career prosecutors at the U.S. Department of Justice often pride themselves on their ability to remain apolitical in order to ensure consistency and keep the department’s mission afloat, and the incoming Trump administration is unlikely to upend this tradition, says Michael Landman at Bird Marella.
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Unpacking Arguments From High Court's Rural Hospital Case
During oral arguments in Advocate v. Becerra, the U.S. Supreme Court justices focused questions on the meaning of being "entitled to" supplementary security income assistance, and there's reason for optimism that the likely split decision will break in favor of hospitals, say attorneys at King & Spalding.
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Health Policy Predictions For Trump's Second Administration
As President-elect Donald Trump's nominations for health policy and enforcement heads work their way through the confirmation process, healthcare organizations can look at nominee backgrounds, campaign statements and actions from Trump's previous presidency to predict incoming priorities, say attorneys at McDermott.
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What Trump's Next Term May Mean For Biz Immigration
Leonard D'Arrigo at Harris Beach discusses the employment-based immigration policies businesses can potentially expect during President-elect Donald Trump’s second term, based on policies enacted during his first administration, statements made during his campaign and proposals in Project 2025.
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Weak Reasoning Underlies Fla. Judge's Bold Qui Tam Ruling
U.S. District Judge Kathryn Mizelle's groundbreaking decision in U.S. ex rel. Zafirov v. Florida Medical Associates LLC, holding that qui tam provisions of the False Claims Act are unconstitutional, relies on weak logic to reach a conclusion that differs from every other court that has ruled on the issue, says Ethan Greenberg at Anderson Kill.
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Medicare Overpayment Rules Are A Mixed Bag For Providers
The Centers for Medicare & Medicaid Services' updated rules for handling agency overpayments adopt a more reasonable definition of what it means to have "identified" an overpayment, which is a win for providers, but their new time frame for investigating related overpayments is unrealistic, says Susan Banks at Holland & Knight.
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Expect More State-Level Scrutiny Of Noncompetes Ahead
Despite the nationwide injunction against the Federal Trade Commission’s noncompete ban, and the incoming Republican administration, employers should anticipate that state legislatures will continue to focus on laws that limit or ban noncompetes, including those that target certain salary thresholds or industries, says Benjamin Fryer at FordHarrison.
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Cos. Should Inventory Issues To Prep For New Congress
As the legislative and oversight agendas of the 119th Congress come into sharper focus, corporate counsel should assess and plan for areas of potential oversight risk — from tax policy changes to supply chain integrity — even as much uncertainty remains, say attorneys at WilmerHale.