Policy & Compliance
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December 17, 2024
Feds Intervene In $200M FCA Case Against CVS
The federal government has intervened in a whistleblower case accusing CVS and its subsidiaries of pocketing more than $200 million in overpayments, in order to defend the constitutionality of the False Claims Act's whistleblower provisions.
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December 17, 2024
5th Circ. Preserves Feds' ACA Trans Health Policy
The Fifth Circuit upended a Texas court decision that invalidated a federal agency interpretation of the Affordable Care Act's provision on nondiscrimination in healthcare, keeping intact federal policy that prohibits insurers from discriminating against individuals seeking treatment for gender dysphoria.
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December 17, 2024
Nurse Survey Rule Case Sheds Light On Loper At 2nd Circ.
A legal challenge over a federal rule saying registered nurses aren’t required at Medicaid compliance inspections is at the center of a Second Circuit case that promises to shed light on how courts could use the Loper Bright decision.
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December 16, 2024
Pa. Malpractice Fund Belongs To State, 3rd Circ. Rules
The Third Circuit said Monday in a precedential ruling that Pennsylvania's medical malpractice insurance fund is an agency of the state and that it can dip into the fund's $300 million budget surplus.
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December 16, 2024
11th Circ. Appears Wary Of Doc's New Trial Bid In $27.5M Case
The Eleventh Circuit on Monday questioned whether a Georgia doctor and his medical practice should get a new trial in a $27.5 million False Claims Act case on the basis that he and an expert who wasn't allowed to testify at trial believed the thousands of treatments he billed for were medically necessary and could be covered by Medicare, saying that contention seems to contradict the doctor's prior statements.
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December 13, 2024
UnitedHealthcare Owes $900K For Services, Provider Says
A national healthcare provider and two affiliated entities told a Minnesota federal court that UnitedHealthcare owes over $900,000 in independent dispute resolution awards entered against the carrier, accusing it of devising a scheme of denying, delaying and underpaying out-of-network providers.
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December 13, 2024
Texas AG Sues NY Doctor Over Telehealth Abortion Script
Texas Attorney General Ken Paxton sued a New York doctor who founded the Abortion Coalition for Telemedicine in the Lone Star State Friday, accusing the physician of violating Texas state abortion laws by providing abortion-inducing prescription drugs to a Texas resident via telehealth.
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December 13, 2024
McKinsey To Pay $650M For Work With Opioid Maker Purdue
Consulting giant McKinsey & Co. will pay $650 million to resolve charges related to its work helping Purdue Pharma market and boost sales of OxyContin, federal prosecutors announced Friday.
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December 12, 2024
3rd Circ. Backs Dismissal Of Anti-Abortion Group's Suit
The Third Circuit on Thursday affirmed the dismissal of an anti-abortion pregnancy center's bid to block the enforcement of a subpoena seeking information about its donors, ruling its constitutional claims are not yet ripe.
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December 12, 2024
Wash. Justices OK Tax Break For Pharmacy Benefits Manager
A Washington pharmacy benefits manager is exempt from a state business tax on its services for Medicaid patients because its corporate sibling paid premium taxes in connection with the same services, the state's high court affirmed Thursday.
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December 12, 2024
Lawmaker Sues Over Firing For Remarks On Jewish Rival
Outgoing Connecticut State Rep. Anabel Figueroa, a Democrat representing Stamford, is suing her ex-employer Nuvance Health Inc. claiming it wrongly fired her over purportedly antisemitic comments she made in a radio interview about her successful primary challenger that she said were taken out of context.
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December 11, 2024
Montana Justices Uphold Temporary Block On Trans Care Ban
Montana's highest court delivered a key victory for transgender youths and healthcare practitioners on Wednesday in a decision finding that privacy rights afforded by Montana's constitution favor a halt to the state's ban on gender-affirming care while litigation against it proceeds.
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December 11, 2024
Split 9th Circ. Nixes Trump-Era Hospital Reimbursement Rule
A split Ninth Circuit on Wednesday struck down a U.S. Department of Health and Human Services policy that boosted the Medicare reimbursement rate for hospitals in lower-income communities, saying the agency's former secretary lacked authority to issue the policy despite his "laudable goal" of helping lower-wage hospitals.
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December 11, 2024
LA Fitness Fights To End DOJ's Gym Accessibility Suit
LA Fitness urged a California federal judge to toss the U.S. Department of Justice's civil enforcement lawsuit alleging the gym chain failed to accommodate patrons with disabilities at its nearly 700 locations across the country, arguing the lawsuit relies on "isolated" incidents and doesn't show "a pattern and practice."
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December 11, 2024
Wisconsin Healthcare Co. Strikes Deal To End 401(k) Fee Suit
A Wisconsin healthcare organization has agreed to settle a proposed class action alleging it allowed its 401(k) plan to pay exorbitant administrative fees and cost employees millions of dollars in retirement savings, according to a Wednesday federal court filing.
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December 10, 2024
Md. Jury Convicts Ex-Biotech Execs On Some Fraud Counts
Two former biotech executives were convicted on some counts Monday following a monthlong Maryland federal court trial in a case alleging they juiced CytoDyn Inc.'s share price by lying to investors about the development of a drug to treat HIV and COVID-19.
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December 10, 2024
3rd Circ. Judge Unsure Subpoena Chills Anti-Abortion Donors
A Third Circuit panel on Tuesday weighed whether an anti-abortion pregnancy center would suffer irreparable harm absent a court order blocking the enforcement of a subpoena seeking information about its donors, questioning whether donors would be imminently chilled if their names are disclosed to New Jersey investigators.
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December 10, 2024
9th Circ. Says Idaho Can't 'Veto' Federal Law In Abortion Row
The Ninth Circuit seemed poised on Tuesday to turn away fresh arguments from Idaho officials claiming a state abortion ban does not conflict with a federal emergency stabilizing law, after the officials said the federal government can't impose conditions on private hospitals receiving Medicare funds.
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December 10, 2024
2nd Circ. Backs Deloitte's Win In 401(k) Fee Suit
The Second Circuit said a trial court correctly tossed a proposed class action by a group of workers claiming Deloitte saddled its $7.3 billion retirement plan with excessive recordkeeping fees, stating they couldn't overcome concerns that their claims amounted to comparisons of apples to oranges.
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December 10, 2024
Transgender High Court Case Puts Light On Parental Rights
When the U.S. Supreme Court heard arguments in a legal battle over a Tennessee ban on gender-affirming care for minors, the conservative justices appeared gripped by a looming issue not directly before them: the rights of parents.
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December 10, 2024
United Health Denials, Patent Antitrust Fight And Neb. Pot Law
United Healthcare must take a third look at its coverage denial for a patient's mental health and substance abuse treatment, and a former state senator asked the Nebraska Court of Appeals to wade into his fight against medical marijuana legalization. Here, Law360 Healthcare Authority looks at the significant cases and decisions that shaped the industry over the last week.
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December 10, 2024
Mich. Panel Advances Bill To Raise Med Mal Damage Caps
Michigan lawmakers could increase the state's caps on certain medical malpractice damages and lift damages caps entirely in cases of extreme misconduct under a proposal approved by a state Senate committee Tuesday.
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December 10, 2024
Doctors Notch Free Speech Wins In 9th Circ. Abortion Cases
A pair of Ninth Circuit rulings last week finding that Idaho can't stop doctors from talking to patients about seeking abortion care in other states is being cheered by abortion and First Amendment advocates as a legal win and a chance to protect healthcare providers' free speech rights.
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December 10, 2024
FTC's Holyoak Says Chair OK With Some Cartels
Federal Trade Commissioner Melissa Holyoak said Lina Khan, the agency's current chair, is suggesting enforcers ignore anticompetitive activity if it's not being committed by what she considers "dominant firms."
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December 10, 2024
FDA Drug Approval Guidance: What You Need to Know
Federal regulators may set clinical trial enrollment targets and impose other conditions on certain studies that pharmaceutical companies must carry out under an accelerated drug-approval program, according to new draft guidance released by the U.S. Food and Drug Administration.
Expert Analysis
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.