Policy & Compliance

  • February 28, 2025

    Aetna, Optum To Pay $8.3M To End ERISA Fee Suit

    Aetna Inc. and OptumHealth Care Solutions LLC will pay $8.3 million to settle 88,000 patients' claims that they were overcharged in a scheme to hide administrative fees as medical expenses, nearly three months after OptumHealth said it was pulling out of the deal.

  • February 27, 2025

    FTC Asks To Delay In-House PBM Insulin Case

    Arguing that pharmacy benefit managers accused of artificially inflating insulin prices have already "unreasonably delayed" discovery, the Federal Trade Commission is asking an in-house judge to push back an evidentiary trial in the case, saying it would allow the administrative court more time to accommodate up to 17 expert witnesses.

  • February 27, 2025

    Unions Can Depose DOGE In Agency Access Suit, Judge Says

    The Department of Government Efficiency must tell a group of unions whom it's sent into the Department of Labor, the Department of Health & Human Services and the Consumer Financial Protection Bureau and what computer systems they've accessed, a D.C. federal judge ruled Thursday.

  • February 27, 2025

    CooperSurgical Says Unique IVF Claims Require Separate Trials

    Fertility company CooperSurgical Inc. is pushing back against the suggestion that four lawsuits accusing the company of negligently destroying embryos with its recalled culture media could be consolidated into one trial, saying the couples' varied location and unique IVF situations preclude joining them.

  • February 27, 2025

    CVS Freed From Hospital's Suit Over Drug Pricing Program

    A Pennsylvania hospital's antitrust lawsuit claiming CVS forced healthcare providers participating in a federal discount drug program to go through the pharmacy chain's administrator has been tossed, with a federal judge ruling the hospital fell short in its allegations of anticompetitive behavior.

  • February 27, 2025

    Cedars-Sinai Strikes Deal To End Retirement Plan Suit

    Cedars-Sinai Medical Center Inc. and a group of retirement plan participants agreed to settle a proposed class action alleging the healthcare system loaded the plan with excessive recordkeeping fees and underperforming investment options, according to a California federal court filing.

  • February 27, 2025

    Polsinelli Blocked From Repping BCBS Settlement Opt-Outs

    An Alabama federal judge has disqualified Polsinelli PC from representing hospitals that opt out of a landmark $2.8 billion Blue Cross Blue Shield antitrust settlement, even as other firms are licking their lips at the prospect of a multibillion-dollar bonanza of opt-out litigation.

  • February 27, 2025

    NC Pharmacy Settles Feds' Suit Over Opioid Records

    A North Carolina pharmacy has agreed to pay $204,000 to resolve allegations that it violated federal recordkeeping requirements for controlled substances, the U.S. Attorney's Office for the Western District of North Carolina announced Thursday.

  • February 26, 2025

    Merck, Glenmark Trim United Healthcare's Zetia Antitrust Suit

    A Minnesota federal judge has trimmed a United Healthcare unit's antitrust suit claiming that Merck and Glenmark conspired to delay a generic version of the anti-cholesterol drug Zetia, throwing out non-Minnesota state-law claims he called a "bare and conclusory pleading."

  • February 26, 2025

    Planned Parenthood Immune From FCA Suit, 5th Circ. Says

    Planned Parenthood is entitled to attorney immunity, the Fifth Circuit said Wednesday in a case that had accused the organization of improperly billing Medicaid programs for millions after losing its Medicaid credentials.

  • February 26, 2025

    CVS Ordered To Comply With FTC's PBM Subpoena

    A D.C. federal judge is ordering CVS to turn over new materials in the Federal Trade Commission's investigation into its pharmacy benefit manager Caremark Rx, saying that just because producing updated documents would cost the company more doesn't mean it faces an "undue burden."

  • February 25, 2025

    DC Judge Blocks Trump's Federal Funding Freeze

    A D.C. federal judge on Tuesday issued a preliminary injunction blocking the Trump administration from implementing a federal spending freeze while a group of nonprofits challenge the freeze, calling the measure "ill-conceived from the beginning."

  • February 25, 2025

    Trump Demands Enforcement Of Healthcare Price Disclosures

    President Donald Trump on Tuesday ordered federal agencies to step up enforcement of regulations requiring hospitals and health plans to publish price information designed to help patients shop for the best deal.

  • February 25, 2025

    Trump Administration In Court: ACA, Trans Care, Drug Pricing

    Directives from the White House threatening gender-affirming care, medical research funding and employment across federal health agencies met resistance in recent days as courts ruled to halt enforcement and states and labor groups filed for injunctive relief.

  • February 25, 2025

    Meet The FDA's New Chief Counsel Robert Foster

    Announced as the top attorney for the U.S. Food and Drug Administration in recent days, Robert Foster brings a career spanning the government's early COVID-19 pandemic response, biopharmaceutical company leadership and legal oversight matters for the U.S. Senate.

  • February 25, 2025

    4th Circ. Shuts Down HHS Chemist's 'Grinch' Harassment Suit

    The Fourth Circuit shut down a chemist's bid Tuesday to revive his suit claiming he faced sex bias and retaliatory harassment within the U.S. Department of Health and Human Services when a colleague called him the "Grinch," ruling his case is devoid of proof of discrimination.

  • February 25, 2025

    3 Attys Reprimanded, 2 DQ'd In Ala. Judge Shopping Probe

    An Alabama federal judge on Tuesday publicly reprimanded three attorneys for judge shopping during their legal efforts against a state law criminalizing gender-affirming care, saying that the trio practiced in bad faith and dropping two of them from litigating the case.

  • February 25, 2025

    'Colossal Neglect' Sinks Walter Reed Fraud Case, Judge Rules

    A Maryland federal judge threw out criminal charges against the alleged mastermind of a more than $3 million healthcare fraud scheme targeting Walter Reed National Medical Center with a Tuesday ruling that ripped prosecutors for "colossal neglect" and "extraordinary, chronic and indefensible" delays in the case.

  • February 25, 2025

    Fired Worker Couldn't Justify COVID Vax Refusal, 3rd Circ. Says

    A software engineer who refused to comply with his company's COVID-19 vaccine policy couldn't claim he had a "sincere religious objection" while shielding his medical records from disclosure and vacillating on his reasons, a Third Circuit panel ruled Tuesday.

  • February 25, 2025

    Pa. Health System Strikes Deal To Exit Workers' OT Suit

    A Pennsylvania health system reached a deal Tuesday to resolve a proposed class action accusing it of stiffing unionized hospital workers on overtime wages, according to a report filed in federal court announcing a successful mediation.

  • February 25, 2025

    Trump's Efficiency Agenda On The Line In Health Job Cuts

    The mass termination of probationary federal employees, including several hundred at the U.S. Department of Health and Human Services, may slow scientific research and harm companies' bottom lines. The Trump administration's efficiency priorities may also be threatened.

  • February 25, 2025

    VA Fires Another 1,400 Employees Amid Dems' Pushback

    The U.S. Department of Veterans Affairs announced Tuesday it is dismissing another 1,400 probationary employees from "non-mission critical" positions amid criticism from Democrats over a round of cuts announced earlier this month.

  • February 25, 2025

    CDC Layoffs Provoke Legal Questions, Worker Anxiety

    Workers and experts with insight into the Centers for Disease Control and Prevention have described the roughly 750 layoffs at the agency as chaotic and confusing, and question Trump's legal authority to unilaterally change the agency. They are also concerned it will impact the agency’s ability to investigate disease outbreaks.

  • February 25, 2025

    1st Circ. Decision Adds To Defense Momentum In FCA Clash

    A First Circuit decision extended a winning streak for the False Claims Act defense bar. The decision's ultimate impact on fraud prosecutions will be shaped by how whistleblowers adjust their legal strategy.

  • February 24, 2025

    PBMs To Challenge FTC Case At 8th Circ., But Without Pause

    A Missouri federal judge summarily refused, again, on Monday to temporarily block the Federal Trade Commission's in-house case accusing Caremark Rx, Express Scripts and OptumRx of artificially inflating insulin prices, letting the case proceed while the pharmacy benefits managers appeal to the Eighth Circuit.

Expert Analysis

  • Proposed Legislation May Crack Down On Online Drug Ads

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    A bill recently proposed in Congress could serve as a sea change in how the U.S. Food and Drug Administration regulates drug-related speech, with significant trickle-down effects on various corners of not only the drug industry but also on consumers and providers themselves, say Dominick DiSabatino and Arushi Pandya at Sheppard Mullin.

  • What To Expect From Calif. Bill Regulating PE In Healthcare

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    A California bill currently awaiting Gov. Gavin Newsom's approval, intended to increase oversight over private equity and hedge fund investments in healthcare, is emblematic of recent increased scrutiny of investments in the space, and may affect transactions and operations in California in a number of ways, say attorneys at Ropes & Gray.

  • Vertex Suit Highlights Issues For Pharma Fertility Support

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    Vertex Pharmaceuticals' recent lawsuit challenging the U.S. Department of Health and Human Services' interpretation of the Anti-Kickback Statute is influenced by a number of reproductive rights and health equity issues that the Office of Inspector General should address more concretely, including in vitro fertilization and fertility preservation programs, says Mary Kohler at Kohler Health Law.

  • CMS' New 'Breakthrough' Device Policy Shows Little Promise

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    The Centers for Medicare & Medicaid Services’ recent procedural notice outlining a new Medicare coverage pathway for breakthrough medical devices will, at best, be a failed experiment and, at worst, result in Medicare beneficiaries denied access to innovative treatments, say attorneys at King & Spalding.

  • A Preview Of AI Priorities Under The Next President

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    For the first time in a presidential election, both of the leading candidates and their parties have been vocal about artificial intelligence policy, offering clues on the future of regulation as AI continues to advance and congressional action continues to stall, say attorneys at Mintz.

  • Managing Community Health Needs Assessments: A Checklist

    Excerpt from Practical Guidance
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    To guide nonprofit hospitals and health systems through their required community health needs assessment every three years, this checklist outlines the steps for 12 phases of the process.

  • Pa. Health Employers Must Prep For Noncompete Restrictions

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    Newly enacted legislation in Pennsylvania prohibits certain noncompete covenants for healthcare practitioners in the state beginning next year, creating compliance challenges that both employers and employees should be aware of, say attorneys at Buchanan Ingersoll.

  • FTC Focus: What Access To Patent Settlements Would Mean

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    Settling parties should adopt a series of practice tips, including specifying rationales to support specific terms, as the Federal Trade Commission seeks to expand its access to settlements before the Patent Trial and Appeal Board, say Shannon McGowan and David Munkittrick at Proskauer.

  • Agencies Should Reward Corporate Cyber Victim Cooperation

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    The increased regulatory scrutiny on corporate victims of cyberattacks — exemplified by the U.S. Securities and Exchange Commission's case against SolarWinds — should be replaced with a new model that provides adequate incentives for companies to come forward proactively and collaborate with law enforcement, say attorneys at McDermott.

  • Strategies To Defend Against Healthcare Nuclear Verdicts

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    The healthcare industry is increasingly the target of megaclaims, particularly those alleging medical malpractice, but attorneys representing providers can use a few tools to push back on flimsy litigation and reduce the likelihood of a nuclear verdict, says LaMar Jost at Wheeler Trigg.

  • What Drug Cos. Must Know About NY Price Transparency Law

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    Drug manufacturers must understand the contours of New York's recently implemented law requiring self-reporting of drug price increases, as well as best practices for compliance and challenges against similar laws in other states, say Elizabeth Bierut and Angie Garcia at Friedman Kaplan.

  • Whistleblowers Must Note 5 Key Differences Of DOJ Program

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    The U.S. Department of Justice’s recently unveiled whistleblower awards program diverges in key ways from similar programs at other agencies, and individuals must weigh these differences and look first to programs with stronger, proven protections before blowing the whistle, say Stephen Kohn and Geoff Schweller at Kohn Kohn.

  • The Licensure Landscape For Psychedelics Manufacturers

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    As the need for bulk manufacturing of psychedelic substances grows, organizations aiming to support clinical trials or become commercial suppliers must navigate a rigorous and multifaceted journey to obtaining a license from the U.S. Drug Enforcement Administration, say Kimberly Chew at Husch Blackwell and Jaime Dwight at Promega Corp.