Policy & Compliance
-
November 21, 2024
Health Exec Who Fled Gets 3 Years For $8M Medicare Scheme
A home healthcare executive who led a scheme to defraud Medicare of nearly $8 million through fraudulent billing practices and who fled the country after his indictment has been sentenced to more than three years in prison, according to a judgment filed in Michigan federal court Wednesday.
-
November 21, 2024
In Tight Vote, Senate Panel OKs Bill To Set New PTAB Limits
The Senate Judiciary Committee on Thursday narrowly voted to advance a bill that would impose new restrictions on Patent Trial and Appeal Board challenges, with several members expressing concern that it could drive up the cost of prescription drugs.
-
November 21, 2024
NY Health Insurer Sued Over Booting Up, Logging Off Time
A New York health insurer failed to pay customer service representatives for the time needed to get their workstations ready, leading to unpaid overtime and missed lunch breaks, according to a proposed class and collective action filed in federal court Friday.
-
November 21, 2024
NY Hospital GC Accuses State Of Mishandling Medicaid Funds
The general counsel of Nassau University Medical Center, who is also serving as interim president and CEO, is leading the Long Island hospital into a legal battle with the state of New York over $1 billion in federal Medicaid funds.
-
November 20, 2024
Musk, Ramaswamy Say High Court Rulings OK Federal Cuts
Billionaire Elon Musk and former presidential candidate Vivek Ramaswamy, President-elect Donald Trump's picks to lead a newly created "Department of Government Efficiency," on Wednesday said two recent U.S. Supreme Court rulings will give them the authority to cut off power to regulatory agencies and conduct massive federal layoffs.
-
November 20, 2024
Hospital's Med Mal Win Axed By Mich. Appeals Panel
A divided Michigan Court of Appeals panel has revived a medical malpractice lawsuit against a Michigan hospital, finding that the patient established a genuine fact dispute regarding her reasonable belief that the gynecologist treating her was acting as the hospital's agent.
-
November 20, 2024
PBMs Sue To Block FTC's In-House Insulin Pricing Case
Caremark Rx, Express Scripts and OptumRx have lodged a constitutional challenge of the Federal Trade Commission's in-house case accusing the pharmacy benefits managers of artificially inflating insulin prices through unfair rebate schemes.
-
November 20, 2024
3 States To Challenge Abortion Regs After Docs Drop Claims
Anti-abortion medical groups that were dealt a loss by the U.S. Supreme Court earlier this year have now dropped out of their lawsuit challenging federal approvals for mifepristone, leaving Missouri, Idaho and Kansas to carry on litigation over the abortion medication.
-
November 19, 2024
W.Va. Amendment Marks Obstacle For Aid-In-Dying Movement
A first-of-its-kind prohibition in West Virginia on medically assisted suicide represents a new form of opposition to a growing movement that supports allowances for doctors to help patients with terminal illnesses end their lives.
-
November 19, 2024
UnitedHealthcare Can't Escape Patient's Proton Beam Suit
A Florida federal judge on Tuesday refused to toss a federal benefits lawsuit from a patient who alleged that UnitedHealthcare wrongly denied him coverage for proton beam therapy to treat tongue cancer, rejecting the insurer's argument that an exclusion for unproven treatments applied.
-
November 19, 2024
Insurers Urge Arbitration Of Union Fund's ERISA Claims
Elevance Health Inc. and several affiliated health insurers want a Connecticut federal judge to force arbitration of claims brought by a union fund that alleges excessive fees violated benefits law, arguing that the companies were unaware of an arbitration agreement with the plaintiff when they started litigating the early stages of a proposed class action.
-
November 19, 2024
Widow Can't Get Malpractice Suit Over Husband's Fall Revived
A North Carolina appeals court on Tuesday declined to reinstate a suit by a widow alleging that nurses at Charlotte-Mecklenburg Hospital were responsible for a fall taken by her husband while he was recovering from brain surgery, saying the trial court rightly excluded her expert's testimony.
-
November 19, 2024
10th Circ. Iffy On Colo.'s Remedy To Generic EpiPen Takings
A Tenth Circuit panel on Tuesday pressed Colorado regulators on whether requiring epinephrine auto-injector makers to repeatedly sue over the cost of complying with a state program provides an adequate legal remedy, with one judge saying that that route offers no finality for manufacturers.
-
November 19, 2024
Trump Taps Dr. Oz For CMS Head
President-elect Donald Trump announced on Tuesday he will nominate TV personality Dr. Mehmet Oz to be administrator of the Centers for Medicare & Medicaid Services.
-
November 19, 2024
Advocates Brace For Trump Shift On Emergency Abortion Law
After an unsatisfactory U.S. Supreme Court decision and the Biden administration battle over the Emergency Medical Treatment and Active Labor Act now back in the circuit courts, abortion access advocates are bracing for another twist: the return of Donald Trump to the White House.
-
November 19, 2024
Nonpracticing Doc Can't Testify In Med Mal Case, Court Says
A Florida state appeals court has affirmed the dismissal of a case accusing a doctor of botching two shoulder surgeries, agreeing with a lower court's findings that a physician-turned-legal-consultant wasn't qualified to testify as the plaintiff's medical expert under the law.
-
November 19, 2024
Akin Adds Another Healthcare Expert To DC Lobbying Team
The former chief health adviser for the Senate Finance Committee's majority has joined Akin Gump Strauss Hauer & Feld LLP's lobbying team in Washington, D.C., weeks after the firm added another healthcare advocate from the national association representing pharmacy benefit managers.
-
November 18, 2024
3rd Circ. Shuts Down Healthcare Workers' Vax Bias Suit
A split Third Circuit panel said a group of Christian workers can't revive suits claiming a healthcare provider illegally fired them for refusing the COVID-19 vaccine on religious grounds, finding they failed to show how their beliefs prevented them from getting immunized.
-
November 15, 2024
Eli Lilly Says HHS Ignores Drug Discount Double-Dipping
Eli Lilly & Co. claims the U.S. Department of Health and Human Services is unlawfully blocking its efforts to crack down on hospitals the company alleges are double-dipping on medication discounts that are meant to benefit low-income patients, according to a lawsuit filed in D.C. federal court.
-
November 15, 2024
HHS Likely To Limit Migrant Data After Flores Deal Ends
A California federal judge indicated Friday that she can't force the U.S. Department of Health and Human Services to provide human rights groups with regular data about children in low-security detention facilities now that the long-running Flores settlement has been replaced with a government regulation.
-
November 15, 2024
PBMs Denied Breakup Of Combined FTC Insulin Price Trial
The Federal Trade Commission's allegations that pharmacy benefit manager giants Caremark Rx, Express Scripts and OptumRx are artificially inflating insulin prices through unfair rebate schemes will forge ahead as a single case following an in-house agency judge's refusal to break them into separate proceedings.
-
November 15, 2024
Despite Vaccine Spotlight, RFK Jr. A Health Policy 'Unknown'
Robert F. Kennedy Jr., President-elect Donald Trump's pick to be the nation's top health official, has made clear his unorthodox and often false views on public health issues like vaccines. But there's still plenty of policy under his potential control where his stance remains opaque, attorneys say, which could stymie their efforts to prepare for the next four years.
-
November 15, 2024
Telehealth Cos. Misclassified Managers, Ex-Worker Says
Two telehealth companies misclassified account managers and client relations directors as overtime-exempt despite their job duties not qualifying for any of the exemptions under the Fair Labor Standards Act, a proposed collective action filed in Florida federal court said.
-
November 15, 2024
Teva Defends Mifepristone Antitrust Case Against Corcept
Teva Pharmaceuticals has asked a California federal judge to reject a bid to dismiss its lawsuit against the maker of a brand-name drug used to treat a rare cortisol disorder, contending its complaint plausibly alleges an illegal scheme to suppress generic competition.
-
November 15, 2024
Attys Get 'Final Warning' In Tepezza Hearing Loss MDL
A magistrate judge has chastised attorneys on both sides of multidistrict litigation involving claims that a thyroid eye disease treatment manufactured by Horizon Pharmaceuticals Inc. causes hearing loss, calling for an end to their "improper" conduct during depositions.
No 'Tin Hats': Fluoride Ruling Offers Options As RFK Eyes Ban
A California federal court decision that plunged deep into the scientific research on fluoride's impact on human health may offer Robert F. Kennedy Jr. and the incoming Trump administration a path to discouraging — or even banning — the fluoridation of drinking water.
Why The CDC May Look Very Different In Trump's 2nd Term
As the healthcare industry braces for significant policy changes under a second Trump administration, some experts say the Centers for Disease Control and Prevention could see the most significant alterations both in mission and structure, in part because of the agency's unique, and vulnerable, position under the law.
Wash. Ballot Win Gives States Blueprint For 'Age Wave' Care
Washington's first-in-the-nation program to provide long-term care insurance backed by a payroll tax won a decisive victory at the polls last week, offering a potential model for other states as baby boomers age out of the workforce and more families seek eldercare.
Expert Analysis
-
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.
-
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.
-
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.
-
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.
-
Incoming Admin May Shake Up Life Sciences Regulation
Though President-elect Donald Trump has not yet articulated policy priorities regarding the life sciences industry, the sector is positioned to see significant changes that could affect everything from drug exclusivity and generic drug approvals, to the availability of over-the-counter drugs, to laboratory-developed tests and digital health, say attorneys at Morgan Lewis.
-
Navigating DOJ's Patchwork Whistleblower Regime
In the past few months, the U.S. Department of Justice and several individual U.S. attorney’s offices have issued different pilot programs aimed at incentivizing individuals to blow the whistle on misconduct, but this piecemeal approach may create confusion and suboptimal outcomes, say attorneys at BakerHostetler.
-
What To Expect Next From Federal Health Tech Regulation
Healthcare organizations should pay close attention to federal health information technology regulators' recent guidance concerning barriers to accessing electronic health information, which signals that more enforcement in this area is likely forthcoming, say attorneys at Ropes & Gray.
-
5 Areas Congress May Investigate After GOP Election Wins
With Republicans poised to take control of Congress in addition to the executive branch next year, private companies can expect an unprecedented uptick in congressional investigations focused on five key areas, including cryptocurrency and healthcare, say attorneys at Cahill Gordon.
-
Takeaways From State Votes On Abortion In The 2024 Election
Attorneys at Epstein Becker discuss how 10 states voted on ballot initiatives to either protect or restrict access to abortion in the 2024 general election, and analyze overarching trends.
-
Loper Bright Offers New Materiality Defense To FCA Liability
The U.S. Supreme Court's decision in Loper Bight Enterprises v. Raimondo, ending Chevron deference, may have created a new defense to False Claims Act liability by providing the opportunity to argue that a given regulation is not material to the government's payment decision, says Tanner Cook at Husch Blackwell.
-
How Expanded Birth Control Coverage May Affect Employers
Employers should consider the potential impact of recently proposed regulations that would expand group health plans' required coverage of preventive services and contraceptives, including questions about how the agencies would implement their plans to eliminate the prescription requirement and alter the exceptions process, says Jennifer Rigterink at Proskauer.
-
Legislation Most Likely To Pass In Lame Duck Session
As Congress begins its five-week post-election lame duck session, attorneys at Greenberg Traurig break down the legislative priorities and which proposals can be expected to pass.
-
Preserving The FCA Is Crucial In Trump's 2nd Term
While the Trump administration may pursue weaker False Claims Act enforcement, it remains an essential tool in safeguarding public funds and maintaining corporate accountability, so now is not the time to undermine ethical behavior, or reduce protections and incentives for whistleblowers, says Adam Pollock at Pollock Cohen.