Policy & Compliance
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September 26, 2024
Behavioral Health Exec Pleads Guilty To Medical Billing Fraud
The chief executive of a behavioral health company on Thursday admitted to directing employees to bill Medicare and Medicaid for extra psychotherapy sessions that never took place.
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September 25, 2024
NY Judge Pauses Abortion 'Reversal' Case As AG Files Appeal
A New York federal judge has ruled that two more anti-abortion pregnancy centers are free to promote abortion pill "reversal" while a legal clash continues over whether the First Amendment protects their right to market the treatment, which is doubted by major medical groups.
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September 25, 2024
Generics Group Names Ex-BIO, PhRMA Exec As New CEO
The generic drug industry group the Association for Accessible Medicines on Wednesday announced it has appointed a new chief executive officer who brings over a decade of experience in the branded drug industry.
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September 25, 2024
DC Circ. Judges Ask If It's Too Late To Fast-Track Gastro Drug
A panel of D.C. Circuit judges grilled an attorney for Vanda Pharmaceuticals on Wednesday over claims Vanda's gastroparesis drug was improperly denied fast-track designation by the Food and Drug Administration, questioning why the company declined to complete animal toxicological studies even after the FDA paused the drug's human trials.
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September 25, 2024
Wash. Hospital System Misclassifies Workers, Nurse Says
A Washington-based hospital operator misclassified its workers as independent contractors and underpaid them for their overtime as a result, a registered nurse said in a proposed class and collective action in Washington federal court.
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September 25, 2024
AmerisourceBergen Can't Escape Workers' 401(k) Fee Suit
AmerisourceBergen Corp. can't escape a proposed class action alleging it allowed its employee 401(k) plan to be saddled with excessive recordkeeping costs, a Kentucky federal judge ruled, saying the workers' claims and calculations were detailed enough to move forward.
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September 24, 2024
Medical Aid-In-Dying Movement Faces Setback In NJ Fight
Advocates for state laws that allow physicians to prescribe lethal medication to terminally ill patients hit a roadblock when a New Jersey federal judge concluded the state can limit it to state residents. Previous challenges in two other states prompted changes to aid-in-dying statues.
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September 24, 2024
Novo Nordisk Tells Sens. Ozempic Costs Are Linked To PBMs
Novo Nordisk's CEO argued Tuesday that the high prices of the company's diabetes and weight loss drugs Ozempic and Wegovy primarily stem from the actions of pharmacy benefit managers, earning support from many members of a Senate committee and frustrating others who wanted more direct answers on the Danish drugmaker's own responsibilities.
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September 24, 2024
NY Diocese Targets Landmark Religion Ruling At High Court
A Roman Catholic diocese in New York and other religious ministries have launched a fresh attempt to get the U.S. Supreme Court to revisit a landmark ruling that restricts religious-freedom challenges to neutral, generally applicable laws.
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September 24, 2024
8th Circ. Grapples With Standing In Battle Over EEOC Regs
The Eighth Circuit appeared to be wrestling Tuesday with whether a group of red states had the right to sue over the U.S. Equal Employment Opportunity Commission's recently finalized pregnant worker regulations, as the states pushed for revival of their challenge to abortion-related components of the rule.
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September 24, 2024
State Courts Take Lead In Fraught Abortion Ballot Battles
A slew of abortion-rights ballot initiatives headed to voters this November are being challenged in state courts, keeping a politically charged issue in front of state judges at a time of historically low public trust in the judiciary.
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September 24, 2024
Firms Allowed To Exit IP Case After Gaining Philips' Consent
A North Carolina federal judge allowed Dentons and Morningstar Law Group to withdraw as Transtate Equipment Co. Inc.'s counsel in a copyright and unfair competition case, after a stipulation was struck with opposing attorneys representing a Dutch health technology conglomerate that initially scoffed at the request.
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September 24, 2024
Insurer Wants Quick Appeal At 8th Circ. In DOL Tax Fight
A health insurer will seek the Eighth Circuit's review after a federal judge refused to toss a suit from the U.S. Department of Labor claiming the company unlawfully took at least $66.8 million in Minnesota state tax liability from plans it administered to pay in-network providers.
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September 24, 2024
Senators Spar Over Abortion Bans Where 'Docs Play Lawyer'
Republican and Democratic senators on Tuesday grappled with whether some states' abortion bans conflict with a federal emergency care law and whether exceptions under those bans put doctors in situations where they must decide between a prison sentence or providing emergency stabilizing care.
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September 24, 2024
Home Care Co. Cuts $400K Deal To End EEOC Race Bias Suit
A home healthcare company has agreed to pay Black and Hispanic employees $400,000 to resolve a U.S. Equal Employment Opportunity Commission suit filed in New York federal court claiming it allowed patients to request — or turn away — their home attendants based on their race.
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September 24, 2024
In Florida, Regulators Eye Brazilian Butt Lift Industry
A spate of patient deaths following a gluteal fat graft — otherwise known as a Brazilian butt lift — has the attention of lawmakers and regulators in Florida, the epicenter of a booming plastic surgery business. The state’s moves may ripple through other parts of the country if the procedure continues to grow in popularity.
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September 23, 2024
'Dreamers' Want In On GOP States' Suit Over ACA Coverage
Deferred Action for Childhood Arrivals recipients and a Maryland nonprofit have moved to intervene in a Republican states-led lawsuit challenging a rule giving DACA beneficiaries access to Affordable Care Act health insurance programs, saying the Biden administration can't adequately represent their interests.
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September 23, 2024
Edelson, Susman, Berger To Lead MultiPlan Collusion MDL
An Illinois federal judge on Monday tapped a team of lawyers from Edelson PC, Susman Godfrey LLP and Berger Montague PC to take the lead for plaintiffs in multidistrict litigation accusing MultiPlan and a host of insurers of colluding through the use of the data firm's pricing tools to systematically underpay out-of-network providers.
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September 23, 2024
Aetna ER Payment Suit Remanded To Ohio State Court
An Ohio federal judge remanded a suit accusing multiple Aetna health insurance entities of underpaying healthcare workers for emergency services they provide to its insureds to state court, stating that to resolve the claims in his own court "would disrupt the state-federal balance of judicial responsibilities."
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September 20, 2024
Arbitration Unlikely For Nursing Home Poison Death Suit
A California state appeals court has all but affirmed the denial of arbitration in a suit alleging a nursing home caused the poisoning death of a resident who was mistakenly served industrial cleaner left in a pitcher, saying the trial court must first review the validity of the arbitration agreement.
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September 20, 2024
5th Circ. Deals Biden A Loss in Medicare Drug Pricing Row
A Fifth Circuit panel majority said that a healthcare trade association has standing to challenge the Biden administration's Medicare drug pricing program, allowing the group to sidestep agency administrative procedure and test its claims in federal court.
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September 20, 2024
3 Atty Takeaways On Mental Health Parity Final Rules
Federal agencies' recently finalized rules for how employer health plans must analyze their coverage of mental health and substance use disorder treatments imposes significant new reporting and disclosure requirements, although regulators backed off more sweeping proposed network design changes. Here are attorneys' three key takeaways from the final mental health parity rules — what made it in, what's out and what to watch for next.
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September 20, 2024
Green Groups Can't Bar Housing Project, SC Judge Says
A South Carolina federal judge on Thursday denied conservation groups' push to block a 9,000-unit housing development on the Cainhoy Peninsula near Charleston, ruling they've not shown they're likely to succeed in a case challenging federal reviews and approvals.
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September 20, 2024
FTC Accuses Drug Middlemen Of Raising Insulin Prices
The Federal Trade Commission on Friday accused the three largest pharmacy benefits managers, Caremark Rx, Express Scripts and OptumRx, of artificially inflating insulin prices by relying on unfair rebate schemes that hurt competition.
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September 19, 2024
Ga. Appeals Court Says Hospital Must Get Certificate Of Need
The Georgia Court of Appeals for the second time has said that a Georgia hospital must obtain a new certificate of need from the state to convert its long-term care beds to short-stay acute care beds, following guidance issued by the state's justices earlier this year.
Expert Analysis
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Gilead Ruling Signals That Innovating Can Lead To Liability
A California appeals court's ruling last month in Gilead Life Sciences v. Superior Court of San Francisco that a drug manufacturer can be held liable for delaying the introduction of an improved version of its medication raises concerns about the chilling effects that expansive product liability claims may have on innovation, says Gary Myers at the University of Missouri School of Law.
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Health Policy Legislative Landscape May Remain Frozen
With Congress again delaying the full resolution of fiscal year 2024 federal spending legislation, there is now an additional window in which Congress could work through several priority issues for healthcare stakeholders, though these issues are unlikely to be resolved in time, say attorneys at Faegre Drinker.
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Despite HHS Opinion, Gift Card Giveaways Require Caution
Though the U.S. Department of Health and Human Services' Office of Inspector General recently determined that a healthcare consulting firm's gift card plans do not violate the Anti-Kickback Statute, the opinion does not suggest blanket approval for providing gift cards in exchange for referrals, say Ragini Acharya and Matthew Deutsch at Husch Blackwell.
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DOJ's Biopharma Settlement Raises Anti-Kickback Questions
In the aftermath of the U.S. Department of Justice's settlement with Ultragenyx over genetic testing programs, it may be prudent to reevaluate genetic tests through the lens of the Anti-Kickback Statute and reconsider whether it is proper for free testing programs to be treated like patient assistance programs, says Mary Kohler at Kohler Health Law.
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Where Justices Stand On Chevron Doctrine Post-Argument
Following recent oral argument at the U.S. Supreme Court, at least four justices appear to be in favor of overturning the long-standing Chevron deference, and three justices seem ready to uphold it, which means the ultimate decision may rest on Chief Justice John Roberts' vote, say Wayne D'Angelo and Zachary Lee at Kelley Drye.
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Bracing For Calif.'s New Health Transaction Framework
As California's new cost and market impact review regulations' April 1 date for its updated notice and review process approaches, healthcare entities should ready themselves for dramatic changes to the state's regulatory landscape and prepare for potentially substantial transaction delays, say Jordan Grushkin and Matthew Goldman at Sheppard Mullin.
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Uncharted Waters Ahead For FCA Litigation In 2024
Following a year of significant court decisions, settlements, recoveries and proposed amendments, 2024 promises to be a lively year for False Claims Act actions and litigation, and one that will hopefully provide more clarity as FCA jurisprudence evolves, say attorneys at Crowell & Moring.
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OIG Report Has Clues For 2024 Healthcare Fraud Enforcement
A recent report from the Health Department's Office of the Inspector General reveals healthcare fraud and abuse enforcement trends that will continue in 2024, from increased telehealth oversight to enhanced policing of managed care, say attorneys at Sheppard Mullin.
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FOIA Exemption Questions On Redacted HHS Cannabis Letter
The U.S. Department of Health and Human Services' recent recommendation letter concerning the rescheduling of cannabis was heavily redacted, and based on an analysis on the applicability of Freedom of Information Act Exemption 5 to the letter, it's likely that we will see successful legal challenges to those redactions, say attorneys at Troutman Pepper.
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A Primer On New Calif. Health Transaction Reporting Rules
New California regulations regarding the reporting of certain transactions involving healthcare entities, which took effect on Jan. 1, address some industry feedback about overly broad requirements but still leave several areas of concern, says Andrew Demetriou at Husch Blackwell.
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In The CFPB Playbook: Rulemaking Rush Before Election Year
In this quarterly Consumer Financial Protection Bureau activity recap by former bureau personnel, attorneys at McGuireWoods explain the regulator's recent push to finalize new rules about data aggregators, digital payment apps and more before the election-year Congressional Review Act window opens.
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What The Law Firm Of The Future Will Look Like
As the legal landscape shifts, it’s become increasingly clear that the BigLaw business model must adapt in four key ways to remain viable, from fostering workplace flexibility to embracing technology, say Kevin Henderson and Eric Pacifici at SMB Law Group.
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4 PR Pointers When Your Case Is In The News
Media coverage of new lawsuits exploded last year, demonstrating why defense attorneys should devise a public relations plan that complements their legal strategy, incorporating several objectives to balance ethical obligations and advocacy, say Nathan Burchfiel at Pinkston and Ryan June at Castañeda + Heidelman.