Policy & Compliance
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October 01, 2024
9th Circ. Revives FCA Claims Against Dermatology Practice
A Ninth Circuit panel on Monday revived the claims of a former employee who accused a Nevada dermatology practice of retaliation under the False Claims Act and other wrongdoing, reversing the practice's early win and sending the case back for trial.
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October 01, 2024
Novel FCA Decision Amplifies Voices Of Whistleblower Critics
A Florida federal judge's characterization of whistleblowers as self-appointed "special prosecutors" when they file lawsuits on the federal government's behalf amplifies the voices of critics questioning the constitutionality of a key enforcement tool for fighting fraud, while threatening to create a circuit split.
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October 01, 2024
11th Circ. Hearsay Ruling May Open Door To Top Court Review
An Eleventh Circuit decision to allow co-conspirator statements under a hearsay rule exclusion in a $400 million health insurance fraud case could stretch the scope of federal fraud law and might draw the attention of the U.S. Supreme Court.
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October 01, 2024
Biotech Investors Reach $32.5M Deal Over Failed COVID Test
A class of Talis Biomedical Corp. investors accusing the company of inflating their stock price in the run-up to its IPO and then failing to launch a COVID-19 diagnostic test asked a California federal judge on Monday to preliminarily approve their $32.5 million settlement, citing Talis' shrinking cash reserves and imminent plans to file for bankruptcy.
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October 01, 2024
Gov't Looks To High Court To Preserve Free Preventive Care
The federal government has taken a fight over the Affordable Care Act's requirements for cost-free preventive care to the U.S. Supreme Court.
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October 01, 2024
Doctors Were 'Bamboozled' By $160M Health Fraud, Jury Told
A Houston man accused of defrauding the government out of $160 million by submitting false claims for diabetes medication is only guilty of creating a competitive business model, his attorney said Tuesday, telling a Texas federal jury it was "ridiculous" to say doctors across the country were "bamboozled" by an alleged scheme.
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October 01, 2024
FDA Chief Talks Shortages, Food Labels, Reorganization
Pharmaceutical supply chain challenges. A major agency reorganization. Rare disease research. These issues were top of mind for U.S. Food and Drug Administration Commissioner Robert Califf in a recent "fireside chat" with the Alliance for a Stronger FDA, a group of trade associations, pharmaceutical companies, health-focused nonprofits and other stakeholders.
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October 01, 2024
Nostrum Labs Hits Ch. 11 A Year After Medicaid Settlement
Nostrum Laboratories, a New Jersey drugmaker that paid millions to settle allegations that it underpaid Medicaid drug rebates for its bladder infection drug after it hiked the price more than 400%, filed for Chapter 11 protection with nearly $68.3 million in debt.
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October 01, 2024
'Unsworn' Actors Sink Qui Tam Provision, Fla. Judge Rules
A Florida federal judge on Monday ruled that the provision of the False Claims Act allowing whistleblowers to bring suits on behalf of the federal government is unconstitutional, dismissing a closely watched Medicare Advantage fraud case and potentially upending a key federal enforcement tool.
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September 30, 2024
Calif. Sues Eureka Hospital For Denying Emergency Abortion
California on Monday sued Providence of St. Joseph Hospital in Eureka for denying an emergency abortion to a woman it diagnosed with a serious pregnancy complication and sending her off to a small community hospital with a bucket and towels.
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September 30, 2024
Takeda End Payors, Direct Buyers Win Antitrust Class Cert.
A New York federal judge Monday adopted a magistrate judge's recommendation to certify two classes of direct purchasers and end payors in consolidated antitrust actions accusing Takeda Pharmaceuticals Co. of unlawfully inflating the price of its diabetes treatment Actos by delaying entry of generic alternatives.
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September 30, 2024
Ga.'s 'Heartbeat' Abortion Ban Struck Down Once Again
Georgia residents had their legal access to abortion temporarily restored Monday as the state's so-called heartbeat abortion ban was again struck down by a judge whose previous move to block the 2019 law had been reversed by the state's highest court.
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September 30, 2024
J&J Backs Off 340B Rebate Plan Following Feds' Objections
Johnson & Johnson abandoned its plan Monday to offer rebates rather than upfront discounts for two medications under the 340B drug pricing law, contending it had no choice after a federal agency threatened to impose excessive penalties.
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September 30, 2024
Physician Assistant Seeks Lenient Term In $10M Fraud Case
A North Carolina physician assistant is looking to spend just one year behind bars after a federal jury in Charlotte found him guilty of rubber-stamping bogus prescriptions for genetic testing, marking a far cry from prosecutors' requested nine-year prison sentence.
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September 27, 2024
Texas AG Wants Austin's Abortion Travel Fund Shut Down
Texas Attorney General Ken Paxton on Friday accused the city of Austin of illegally using taxpayer funds to cover travel costs for people traveling out of the Lone Star State to get abortions, claiming that the city is misappropriating the funds in violation of the state constitution.
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September 27, 2024
Kappos' Bayh-Dole Warning To Clients Draws Debate
An advocate for lowering drug prices squared off Friday against a former U.S. Patent and Trademark Office director about the potential risk of accepting government funds to develop drugs, as part of a discussion at New York University School of Law.
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September 27, 2024
Acadia To Pay $19.9M For Alleged Inpatient Billing Scheme
Acadia Healthcare will pay $19.85 million to settle allegations it billed false claims to the federal government for medically unnecessary behavioral health services provided to patients who weren't even eligible for treatment, the U.S. Department of Justice announced.
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September 27, 2024
Why Many Drugs Remain Pricey 40 Years After Hatch-Waxman
In the four decades since Congress passed the Hatch-Waxman Act in an effort to make generic drugs more available, the pharmaceutical industry has used patent thickets, "evergreening" and pay-for-delay tactics to block competition and keep prices of life-saving specialty drugs astronomical, several legal experts told Law360, while the industry argues other parties shoulder more of the blame.
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September 27, 2024
MetLife's 3rd Circ. Win Won't Stop ERISA Health Fee Suits
The Third Circuit's recent decision upholding MetLife's escape from a lawsuit accusing the company of pocketing $65 million in pharmacy rebates instead of using the funds to lower employee healthcare costs hands additional authority over to employers facing a new wave of class action litigation over excessive health fees, attorneys say.
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September 27, 2024
Medical Equipment Co., Founder Settle FCA Suit For $20M
A Florida-based medical equipment company and its founder will pay $20 million to settle claims under the federal False Claims Act that they improperly billed government healthcare plans for duplicated and unnecessary sales of devices meant to offer pain relief through electrical stimulation, Pennsylvania prosecutors said Friday.
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September 26, 2024
Virtua Discriminates Against Pregnant Patients, NJ Alleges
Virtua Health discriminates against pregnant patients by forcing them to undergo drug testing for inpatient admission to its hospitals — a policy that does not apply universally to other patients, New Jersey Attorney General Matthew J. Platkin alleged in a lawsuit filed Thursday in New Jersey state court.
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September 26, 2024
Winner Of $8.6M Suit Wants Mich. Justices' Take On Cap
The estate of a patient who won an $8.6 million medical malpractice verdict earlier this year is asking a Michigan federal court to certify a question to the state's Supreme Court to determine whether a statutory cap on noneconomic damages is constitutional.
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September 26, 2024
Senate Patent Bill Markups Delayed Until After Election
Congressional hearings scheduled for Thursday to mark up several bills related to patents, including measures dealing with patent eligibility, validity challenges and drug patents, have been postponed until after Election Day due to the Senate's adjournment.
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September 26, 2024
NY Lawmakers Beat ADA Suit Over Contentious Mask Ban
A New York federal judge threw out a challenge to Nassau County's ban on face masks worn by people trying to hide their identities in public, noting in an order Wednesday the plaintiffs lack standing since the ban doesn't apply to coverings worn to protect the wearer's health and safety.
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September 26, 2024
Healthcare Atty Rejoins Polsinelli After Foley Hoag Stint
Polsinelli PC announced on Wednesday that a doctor and former healthcare policy attorney who spent 11 years during a previous stint with the firm has returned to its Washington, D.C., office as a public policy shareholder.
Expert Analysis
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Spartan Arbitration Tactics Against Well-Funded Opponents
Like the ancient Spartans who held off a numerically superior Persian army at the Battle of Thermopylae, trial attorneys and clients faced with arbitration against an opponent with a bigger war chest can take a strategic approach to create a pass to victory, say Kostas Katsiris and Benjamin Argyle at Venable.
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The Road Ahead For Florida's Drug Importation Program
Though the U.S. Food and Drug Administration approved Florida's drug importation program in January, a series of hurdles — including requisite buy-in from Canada — and potential legal challenges must be addressed before importation can begin, say attorneys at Ropes & Gray.
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Assessing CDC's Revised Guideline On Opioid Prescriptions
Kenneth Weinstein, Nicholas Van Niel and Kate Uthe at Analysis Group look at newly available data to evaluate the impact that the Centers for Disease Control and Prevention's revised opioid monitoring guideline have had on prescription trends in recent years, highlighting both specific and overall decreases.
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Valeant Ruling May Pave Way For Patent-Based FCA Suits
The Ninth Circuit’s recent ruling in Silbersher v. Valeant marks a significant development in False Claims Act jurisprudence, opens new avenues for litigation and potentially raises the stakes for patent applicants who intend to do business with the government, say Joshua Robbins and Rick Taché at Buchalter.
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Suits Against Insulin Pricing Are Driven By Rebate Addiction
A growing wave of lawsuits filed by states, cities and counties against insulin manufacturers and pharmacy benefit managers improperly allocate the blame for rising insulin costs, when in actuality the plaintiffs are partially responsible, says Dan Leonard at Granite Capitol Consulting.
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When Physician Retirement Arrangements May Be Legal
A recent advisory opinion from the Office of Inspector General regarding physician retirement arrangements sheds light on key considerations and mitigating factors that may be useful when attempting to balance healthcare operational needs with statutory conformity, says Magda Rodriguez at Day Pitney.
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ESG Around The World: Gulf Cooperation Council
The Gulf Cooperation Council is in the early stages of ESG policy implementation, but recent commitments by both states and corporations — including increases in sustainable finance transactions, environmental commitments, female representation on boards and human rights enforcement — show continuing progress toward broader ESG goals, say attorneys at Cleary.
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Navigating ACA Reporting Nuances As Deadlines Loom
Stephanie Lowe at Liebert Cassidy walks employers through need-to-know elements of Affordable Care Act reporting, including two quickly approaching deadlines, the updated affordability threshold, strategies for choosing an affordability safe harbor, and common coding pitfalls.
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Lessons From Rare Post-Verdict Healthcare Fraud Acquittal
A Maryland federal court recently overturned a jury verdict that found a doctor guilty of healthcare fraud related to billing levels for COVID-19 tests, providing defense attorneys with potential strategies for obtaining acquittals in similar prosecutions, says attorney Andrew Feldman.
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ChristianaCare Settlement Reveals FCA Pitfalls For Hospitals
ChristianaCare's False Claims Act settlement in December is the first one based on a hospital allegedly providing private physicians with free services in the form of hospital-employed clinicians and provides important compliance lessons as the government ramps up scrutiny of compensation arrangements, say attorneys at Sheppard Mullin.
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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.