Policy & Compliance

  • December 17, 2024

    NC Panel Revives Negligence Suit Against State Health Dept.

    An adult care center's constitutional claims accusing the North Carolina Department of Health and Human Services of negligently asserting bogus penalties and unfairly suspending admissions at the facility are timely, a North Carolina state appellate panel ruled Tuesday, reviving a case that previously landed before the North Carolina Supreme Court.

  • December 17, 2024

    3 Healthcare Decisions This Week You Don't Want To Miss

    The Third Circuit issued a precedential ruling allowing Pennsylvania to dip into the $300 million budget surplus of an insurance fund for doctors facing medical malpractice claims. Meanwhile in Texas, a split appellate panel found that a member of a national hospital chain can enforce an arbitration agreement with an employee. 

  • December 17, 2024

    Express Scripts, OptumRx Can't Ditch LA County Opioid Suit

    A California judge ruled Tuesday that Los Angeles County can keep pursuing a lawsuit claiming pharmacy benefit managers Express Scripts and OptumRx colluded with drugmakers to fuel the opioid epidemic, though the county must rework its complaint to specify how regulators were allegedly deceived.

  • December 17, 2024

    House GOP Asks CVS How Its PBM Treats Smaller Pharmacies

    Lawmakers on Capitol Hill are demanding documents from CVS on its pharmacy benefit manager's treatment of independent pharmacies, continuing to press the healthcare giant over potentially anticompetitive conduct.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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. 

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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."

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

Expert Analysis

  • A Primer On Navigating The Conrad 30 Immigration Program

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    As the Conrad 30 program opens its annual window to help place immigrant physicians in medically underserved areas, employers and physicians engaged in the process must carefully understand the program's nuanced requirements, say Andrew Desposito and Greg Berk at Sheppard Mullin.

  • Class Actions At The Circuit Courts: September Lessons

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    In this month's review of class action appeals, Mitchell Engel at Shook Hardy identifies practice tips from four recent class certification rulings involving denial of Medicare reimbursements, automobile insurance disputes, veterans' rights and automobile defects.

  • Proposed Legislation May Crack Down On Online Drug Ads

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    A bill recently proposed in Congress could serve as a sea change in how the U.S. Food and Drug Administration regulates drug-related speech, with significant trickle-down effects on various corners of not only the drug industry but also on consumers and providers themselves, say Dominick DiSabatino and Arushi Pandya at Sheppard Mullin.

  • What To Expect From Calif. Bill Regulating PE In Healthcare

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    A California bill currently awaiting Gov. Gavin Newsom's approval, intended to increase oversight over private equity and hedge fund investments in healthcare, is emblematic of recent increased scrutiny of investments in the space, and may affect transactions and operations in California in a number of ways, say attorneys at Ropes & Gray.

  • Vertex Suit Highlights Issues For Pharma Fertility Support

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    Vertex Pharmaceuticals' recent lawsuit challenging the U.S. Department of Health and Human Services' interpretation of the Anti-Kickback Statute is influenced by a number of reproductive rights and health equity issues that the Office of Inspector General should address more concretely, including in vitro fertilization and fertility preservation programs, says Mary Kohler at Kohler Health Law.

  • CMS' New 'Breakthrough' Device Policy Shows Little Promise

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    The Centers for Medicare & Medicaid Services’ recent procedural notice outlining a new Medicare coverage pathway for breakthrough medical devices will, at best, be a failed experiment and, at worst, result in Medicare beneficiaries denied access to innovative treatments, say attorneys at King & Spalding.

  • A Preview Of AI Priorities Under The Next President

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    For the first time in a presidential election, both of the leading candidates and their parties have been vocal about artificial intelligence policy, offering clues on the future of regulation as AI continues to advance and congressional action continues to stall, say attorneys at Mintz.

  • Managing Community Health Needs Assessments: A Checklist

    Excerpt from Practical Guidance
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    To guide nonprofit hospitals and health systems through their required community health needs assessment every three years, this checklist outlines the steps for 12 phases of the process.

  • Pa. Health Employers Must Prep For Noncompete Restrictions

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    Newly enacted legislation in Pennsylvania prohibits certain noncompete covenants for healthcare practitioners in the state beginning next year, creating compliance challenges that both employers and employees should be aware of, say attorneys at Buchanan Ingersoll.

  • FTC Focus: What Access To Patent Settlements Would Mean

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    Settling parties should adopt a series of practice tips, including specifying rationales to support specific terms, as the Federal Trade Commission seeks to expand its access to settlements before the Patent Trial and Appeal Board, say Shannon McGowan and David Munkittrick at Proskauer.

  • Agencies Should Reward Corporate Cyber Victim Cooperation

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    The increased regulatory scrutiny on corporate victims of cyberattacks — exemplified by the U.S. Securities and Exchange Commission's case against SolarWinds — should be replaced with a new model that provides adequate incentives for companies to come forward proactively and collaborate with law enforcement, say attorneys at McDermott.

  • Strategies To Defend Against Healthcare Nuclear Verdicts

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    The healthcare industry is increasingly the target of megaclaims, particularly those alleging medical malpractice, but attorneys representing providers can use a few tools to push back on flimsy litigation and reduce the likelihood of a nuclear verdict, says LaMar Jost at Wheeler Trigg.

  • What Drug Cos. Must Know About NY Price Transparency Law

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    Drug manufacturers must understand the contours of New York's recently implemented law requiring self-reporting of drug price increases, as well as best practices for compliance and challenges against similar laws in other states, say Elizabeth Bierut and Angie Garcia at Friedman Kaplan.