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Policy & Compliance

  • March 17, 2025

    PBMs Hit With Antitrust Suit Over GoodRx Generics Program

    A Denver pharmacy has filed a proposed class action against GoodRx, CVS and other major pharmacy benefit managers in Colorado federal court, alleging they engaged in an illegal price-fixing scheme that artificially suppressed the prices paid to independent pharmacies for reimbursement of generic drug claims.

  • March 17, 2025

    VA To End Medical Care For Gender Dysphoria

    The U.S. Department of Veterans Affairs will stop offering medical treatments for gender dysphoria in order to comply with an executive order by President Donald Trump, the agency announced Monday.

  • March 17, 2025

    Full 7th Circ. Won't Revive Suit Over Late Medicaid Payments

    The full Seventh Circuit has answered the "enormous question" of whether a Chicago hospital can sue the state of Illinois to force the managed-care organizations it contracts with to make timely Medicaid payments, concluding the hospital doesn't have a federal right to prompt payments for fear of turning federal trial courts into "de facto Medicaid claims processors."

  • March 17, 2025

    May Trial Set For Ex-Conn. Official's New Corruption Charges

    A Connecticut federal judge said Monday that former Constitution State budget official Konstantinos Diamantis and ex-lawmaker Christopher Ziogas will go to trial on May 7 for claims they respectively took and paid bribes to stop a state audit of Ziogas' fiancée, who has admitted to healthcare fraud.

  • March 17, 2025

    House Panel Probes Medical Residency Antitrust Exemption

    The chair of the House Judiciary Committee's antitrust panel is looking into whether to do away with an antitrust exemption Congress granted over 20 years ago to the medical residency matching system, which the congressman said could be harming new doctors and even patients.

  • March 17, 2025

    Houston Midwife Arrested In Texas' 1st Criminal Abortion Case

    A Houston-area midwife has been arrested after an investigation by the Texas attorney general's office for allegedly providing illegal abortions, Attorney General Ken Paxton announced Monday, the first such criminal charges brought since the state issued its near-total abortion ban.

  • March 17, 2025

    Feds Defend Prof's Deportation As Arnold & Porter Withdraws

    Government lawyers told a Massachusetts federal judge Monday they did not disobey a court order halting the deportation of a Brown University doctor and professor with an H-1B visa, as a team of Arnold & Porter Kaye Scholer LLP lawyers who lobbed that claim abruptly withdrew from the case.

  • March 17, 2025

    Seeger Weiss Atty Tapped To Lead Depo-Provera Plaintiffs

    A Florida federal judge on Sunday selected Christopher Seeger of Seeger Weiss LLP to lead the team representing plaintiffs in the multidistrict litigation claiming Pfizer Inc. failed to adequately warn patients and doctors about the risk of brain tumors associated with the hormonal contraceptive drug Depo-Provera.

  • March 14, 2025

    Ga. Panel Says COVID-Era Legal Shield Blocks Amputee's Suit

    A divided Georgia Court of Appeals on Friday said a trial court should have dismissed a wrongful amputation suit against a Marietta hospital, holding that the patient who lost his right leg after being admitted for COVID-19 symptoms could not beat the legal immunity granted to the hospital by a pandemic-era state law.

  • March 14, 2025

    Md. Judge Joins Calif. In Reversing Federal Workers' Firing

    A Maryland federal judge has ordered the reinstatement of thousands of probationary employees who were abruptly fired from 18 federal agencies, saying the Trump administration's lack of required notice left states "scrambling" to pick up the pieces.

  • March 14, 2025

    NC Ex-Doctor Gets 2.5 Years For Drug Test Billing Scheme

    A 72-year-old doctor in North Carolina was sentenced Friday to two and a half years in prison and ordered to hand over $2 million in restitution for a fraudulent billing scheme involving medically unnecessary drug tests, prosecutors said.

  • March 14, 2025

    FTC Urges 8th Circ. Not To Pause Insulin Pricing Case

    The Federal Trade Commission has urged the Eighth Circuit not to pause its in-house case accusing Caremark Rx, Express Scripts and OptumRx of artificially inflating insulin prices, telling the appeals court the pharmacy benefit managers have no chance of winning on their constitutional claims.

  • March 14, 2025

    Dr. Oz Pledges 'Upcoding' Crackdown If Confirmed At CMS

    Dr. Mehmet Oz told lawmakers he would combat rising healthcare costs by showing there's a "new sheriff in town" opposed to so-called upcoding by Medicare Advantage plans, as he sought support Friday for his nomination to lead the U.S. Centers for Medicare and Medicaid Services.

  • March 14, 2025

    Sutter Health Reaches $4.3M Deal To End Retirement Suit

    Nonprofit healthcare system Sutter Health will pay $4.3 million to settle a class action from workers alleging their employee retirement plan was saddled with excessive fees and poorly performing investments, according to filings in California federal court.

  • March 14, 2025

    Feds Say North Carolina Cardiologist Owes $7.9M In Taxes

    A North Carolina cardiologist owes the federal government $7.9 million in taxes, fees and interest, according to a new civil complaint brought against him by the tax division of the U.S. Department of Justice seeking to hold him liable for the purportedly unpaid sum.

  • March 13, 2025

    Colo. Says Its Abortion 'Reversal' Ban Doesn't Discriminate

    The Colorado Medical Board and Colorado Board of Nursing have urged a federal court to leave in place a state law banning the use of medication to "reverse" the abortion pill, arguing that it merely regulates "substandard ineffective medical practices" and doesn't discriminate against religious health providers.

  • March 13, 2025

    Ohio Health Insurer Wins $24M Verdict ln Racketeering Case

    An Ohio jury has awarded Medical Mutual of Ohio more than $24 million in damages, after the insurer accused its rivals FrontPath Health Coalition and HealthScope Benefits of undercutting the bidding process for healthcare contracts with the city of Toledo.

  • March 13, 2025

    NY AG James Pitches Bill To Expand Consumer Protection Âé¶¹´«Ã½

    New York Attorney General Letitia James on Thursday announced legislation that would expand the state's ban on deceptive business practices to also protect against unfair and abusive practices, an idea backed by Biden-era Federal Trade Commission and Consumer Financial Protection Bureau heads.

  • March 13, 2025

    Calif. AG Appealing State Limits On Pay-For-Delay Ban

    California enforcers are appealing to the Ninth Circuit after a lower court found that a new state law restricting "reverse payment" settlements between brand-name and generic-drug makers cannot be used to regulate deals that were struck outside the state.

  • March 13, 2025

    PBMs Tell FTC 5-Month Delay Too Long For In-House Insulin Trial

    The nation's "Big Three" pharmacy benefit managers say they want to get to trial in the Federal Trade Commission's administrative suit against them sooner rather than later, arguing that the agency's request for a five-month delay would be too long, but they're open to a three-week postponement.

  • March 13, 2025

    HHS Calls Back Terminated Attys Clearing Medicare Appeals

    The U.S. Department of Health and Human Services on Thursday moved to reinstate about 15 attorneys who were cut loose in recent weeks, restoring staff many in the agency saw as critical to clearing a backlog of Medicare appeals.

  • March 13, 2025

    9th Circ. Ends Idaho Abortion Âé¶¹´«Ã½ Row After Mutual Dismissal

    A Ninth Circuit panel has dropped an appeal from Idaho claiming the state's strict abortion ban doesn't conflict with a federal law protecting emergency abortions, after the Trump administration announced its decision to drop the Biden-era legal challenge. 

  • March 13, 2025

    Days Into New Role, FDA's Top Âé¶¹´«Ã½yer Is Out

    The top lawyer of the U.S. Food and Drug Administration resigned just two days after she was selected for the role, according to a Thursday announcement by the agency on social media site X.

  • March 13, 2025

    Lacking Votes, White House Pulls Weldon Nomination At CDC

    The White House pulled Dr. Dave Weldon's nomination to lead the Centers for Disease Control and Prevention on Thursday after support among GOP lawmakers wavered, and it became clear he didn't have the votes to clear a Senate committee.

  • March 12, 2025

    GOP Senators Take Aim At CFPB Medical Debt Rule

    Republican senators have introduced a measure to overturn the Consumer Financial Protection Bureau's recent rule banning medical debt from credit reports, one of the latest Biden-era regulations to be targeted for legislative repeal.

Expert Analysis

  • Despite HHS Opinion, Gift Card Giveaways Require Caution

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    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.

  • DOJ's Biopharma Settlement Raises Anti-Kickback Questions

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    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 Âé¶¹´«Ã½.

  • Where Justices Stand On Chevron Doctrine Post-Argument

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    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.

  • Bracing For Calif.'s New Health Transaction Framework

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    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.

  • Uncharted Waters Ahead For FCA Litigation In 2024

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    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.

  • OIG Report Has Clues For 2024 Healthcare Fraud Enforcement

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    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.

  • FOIA Exemption Questions On Redacted HHS Cannabis Letter

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    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.

  • A Primer On New Calif. Health Transaction Reporting Rules

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    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.

  • In The CFPB Playbook: Rulemaking Rush Before Election Year

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    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.

  • What The Âé¶¹´«Ã½ Firm Of The Future Will Look Like

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    As the legal landscape shifts, it’s become increasingly clear that the BigÂé¶¹´«Ã½ 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 Âé¶¹´«Ã½ Group.

  • 4 PR Pointers When Your Case Is In The News

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    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.

  • Digging Into The Debate On FDA's Proposed Lab Test Rule

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    A proposed 10-word amendment from the U.S. Food and Drug Administration represents a sea change in device regulation as it would summarily end decades of FDA enforcement discretion for laboratory developed tests, and the public comments offer some insight into the future of this long-running saga, say attorneys at Mintz.

  • Âé¶¹´«Ã½ Firm Strategies For Successfully Navigating 2024 Trends

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    Though law firms face the dual challenge of external and internal pressures as they enter 2024, firms willing to pivot will be able to stand out by adapting to stakeholder needs and reimagining their infrastructure, says Shireen Hilal at Maior Consultants.