Policy & Compliance
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April 15, 2025
Medicare Advantage 'Upcoding' In Federal Crosshairs
Dr. Mehmet Oz and others have called for a crackdown on fraud and waste in privately run Medicare plans. But addressing "upcoding" won't be easy, and healthcare attorneys are watching to see whether the increased attention translates into actual enforcement.
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April 15, 2025
Abortion Bans At Wyo. High Court: 3 Things To Know
Wyoming’s highest court is set to hear arguments over whether two near-total abortion bans violate the state Constitution and its guarantee of personal choice in healthcare.
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April 14, 2025
9th Circ. Says $24M Punitive Damages In Jail Death Too Steep
A jury correctly determined that a healthcare contractor was liable for the death of a woman in custody in a Washington jail, a split Ninth Circuit panel ruled Monday, but its $24 million award for punitive damages was excessive.
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April 14, 2025
Ark. PBM Regulation Violates ERISA, Teamsters Fund Says
An Arkansas insurance regulation forcing health plans to turn over information about reimbursement rates negotiated by pharmacy benefit managers, or PBMs, conflicts with federal benefits law, a Teamsters healthcare fund claimed, urging an Illinois federal court to block the state from enforcing the rule.
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April 14, 2025
Judge Threatens Penalties Over Late Report In Fla. Fee Suit
A Florida federal judge threatened parties in a federal proposed class action over excessive fees charged to maintain retirement savings plans, warning there will be sanctions if they do not respond to an order to show why they failed to timely file a case management report.
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April 14, 2025
Quinn Emanuel, King & Spalding Rep Harvard In Trump Letter
Harvard University on Monday turned to a pair of high-powered lawyers from Quinn Emanuel Urquhart & Sullivan LLP and King & Spalding LLP as the school pushed back on the Trump administration's policy demands linked to nearly $9 billion in federal funding — a move that prompted the government to freeze more than $2 billion in grants for the school.
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April 14, 2025
FTC Joins DOJ In Targeting Anticompetitive Regulations
The Federal Trade Commission launched a public inquiry Monday to look into reducing regulations that are hindering competition, following a similar move by the U.S. Department of Justice last month.
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April 14, 2025
Takeda Gets Actos Case Paused For Class Cert. Review
A New York federal court has paused a lawsuit accusing Takeda Pharmaceuticals of inflating the price of its diabetes treatment, Actos, by delaying the entry of generic alternatives, and took a scheduled July trial off the calendar, as the company appeals a class certification ruling.
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April 14, 2025
Healthcare Duo Joins Carlton Fields From Mass. Boutique
Carlton Fields announced Monday that a pair of experienced healthcare attorneys joined the firm's Los Angeles and Tampa, Florida, offices after a stint with Massachusetts boutique Kajko Weisman & Colasanti LLP.
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April 14, 2025
Sandoz Sues Amgen Over Enbrel Biosimilar
Sandoz accused Amgen of illegally blocking biosimilar competition to its blockbuster Enbrel drug for arthritis and other inflammatory diseases, alleging that the company used strategic acquisitions and illegal patent extensions to fend off challengers in the space and inflate U.S. prices for its drug.
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April 11, 2025
Amgen Can't Ditch Regeneron's Bundling Antitrust Suit
A Delaware federal judge on Thursday denied Amgen's bid to toss antitrust litigation brought by Regeneron accusing its rival of using a bundling scheme to increase the sales of its cholesterol drug Repatha and push competitors out of the market.
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April 11, 2025
Express Scripts Judge Asks If Khan's FTC Exit Affects Suit
The Missouri federal judge overseeing Express Scripts' lawsuit accusing the Federal Trade Commission of defaming it with a report excoriating the pharmacy benefits manager for allegedly inflating drug costs asked the parties Friday if new leadership at the commission affects the case that significantly targets former Chair Lina Khan.
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April 11, 2025
Telehealth Co. Sued Over 2024 Data Breach
A company that helps healthcare providers manage after-hours patient calls was hit with a proposed class action in New York federal court Friday alleging that it failed to secure user data prior to a 2024 breach that exposed the sensitive information of nearly 1 million people.
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April 11, 2025
Fla. Pharmacy Pleads Guilty To Fraud Over Opioid OD Drug
A Florida-based pharmacy has agreed to plead guilty to healthcare fraud and to pay more than $1 million to settle civil claims it submitted false authorizations for an expensive opioid overdose treatment to federal insurers.
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April 10, 2025
AbbVie Wants ND, SD Drug Pricing Laws Blocked
Drugmaker AbbVie Inc. on Thursday asked federal courts to block new drug-pricing laws in both North Dakota and South Dakota, alleging that the measures requiring the company to transfer products to certain pharmacies at discounted prices are unconstitutional.
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April 10, 2025
Vanda Sues FDA To Block Off-Label Use Drug Promo Regs
A pharmaceutical company, a Texas physician and an often-jet lagged traveler sued the U.S. Food and Drug Administration in Texas federal court Wednesday seeking to block marketing restrictions on the off-label uses of FDA-approved drugs, arguing that long-standing rules and Biden-era guidance runs afoul of the First Amendment.
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April 10, 2025
Calif. Centers Used 'Body Brokers' In $10M Scam, BCBS Says
Blue Cross Blue Shield of Oklahoma slammed two California recovery centers and their owners with a lawsuit Thursday, alleging they spearheaded a $10 million kickback scheme to employ "body brokers" to find Indigenous patients for substance treatment facilities where they went to appalling lengths to stop them from leaving.
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April 10, 2025
Holmes Seeks Full 9th Circ. Review Of Theranos Fraud Appeal
Convicted Theranos Inc. founder Elizabeth Holmes has asked the Ninth Circuit for en banc review of a panel's decision to affirm her criminal fraud conviction and 11-year prison sentence, saying problems with the opinion included a "time-warping relevance theory."
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April 10, 2025
Man Admits To $12.5M PPE Investment Fraud
A California man pled guilty Thursday to defrauding investors of $12.5 million by telling them he had a business opportunity to manufacture personal protective equipment and to create an aerosol product that would kill the coronavirus, Texas federal prosecutors said.
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April 10, 2025
Mich. Justices Mull Hospital's Liability For Contract Doc's Acts
The Michigan Supreme Court on Thursday weighed a Corewell Health hospital's possible vicarious liability for independent physicians practicing within the hospital, with one justice pushing back on the idea that liability would be limited to emergency rooms.
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April 09, 2025
Mass. Justices Asked To Raise Bar For Pension, Benefit Loss
Massachusetts' highest court was asked on Wednesday to adopt a more expansive interpretation of what constitutes cruel or unusual punishment or an excessive fine in the case of a former state trooper whose $1 million public pension and healthcare benefits were forfeited after his conviction in an overtime fraud case.
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April 09, 2025
2nd Circ. Allows Takeda To Appeal Actos Antitrust Class Cert.
A split Second Circuit will allow Takeda Pharmaceuticals Co. to immediately appeal a New York federal judge's ruling certifying two classes of direct purchasers and end payors in consolidated antitrust actions accusing the company of unlawfully inflating the price of its diabetes treatment Actos by delaying the entry of generic alternatives.
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April 09, 2025
Fertility Care Concerns Linger As PWFA Regs Face Revision
Efforts to pare down the U.S. Equal Employment Opportunity Commission's regulations requiring workplace accommodations for pregnancy-related conditions have centered largely on abortion, but experts warn that access to fertility treatment — which workers seek more frequently — may also become harder to get.
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April 09, 2025
Data Co. Can't Make DOL Accept Health Plan, Judge Says
A data-mining company can't force the U.S. Department of Labor to acknowledge that a health insurance plan offered in exchange for participants' user data is covered by federal benefits law, a Texas federal judge ruled, saying the case's thin record prevented the court from deciding issues the Fifth Circuit told it to consider.
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April 09, 2025
Religious Mission Justifies Philly Injection Site, 3rd Circ. Told
Counsel for a nonprofit seeking to open a safe injection site in Philadelphia told the Third Circuit Wednesday that it qualified as a religious organization immune from prosecution, despite not having any spiritual language in its incorporation documents.
Expert Analysis
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15 Areas That Would Change Under Health Data Rule Proposal
If finalized, the Office of the National Coordinator for Health Information Technology's proposed rule will significantly progress its efforts to advance interoperability, respond to stakeholder concerns and clarify compliance with the health IT certification program, say attorneys at Ropes & Gray.
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3 Healthcare FCA Deals Provide Self-Disclosure Takeaways
Several civil False Claims Act settlements of alleged healthcare fraud violations over the past year demonstrate that healthcare providers may benefit substantially from voluntarily disclosing potential misconduct to both the U.S. Department of Justice and the U.S. Department of Health and Human Services, say Brian Albritton and Raquel Ramirez Jefferson at Phelps Dunbar.
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Takeaways From High Court's Tribal Health Admin Cost Ruling
The U.S. Supreme Court's recent determination that the government must reimburse two Native American tribes for administrative healthcare costs will help tribes maintain equal footing with the Indian Health Service when administering programs, and continues a pattern of how the current court aligns on tribal concerns, say attorneys at Lewis Roca.
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FTC Focus: Private Equity Investments In Healthcare
As the Federal Trade Commission is tightening its scrutiny of private equity investment in healthcare, the agency is finding novel grounds to challenge key focus areas, including rollup acquisitions, the flip-and-strip approach and minority investments in rival providers, say attorneys at Proskauer.
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High Court's Expert Ruling May Help Health Fraud Defendants
The U.S. Supreme Court's decision in Diaz v. U.S. appears to give the government a powerful new tool in calling its own agents as expert witnesses, but it could also benefit defense counsel in criminal healthcare fraud and other white collar criminal cases that arise in complex legal or regulatory environments, say attorneys at Holland & Knight.
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Unpacking HHS' Opinion On Cell Therapy Refund Programs
A recent advisory opinion from the U.S. Department of Health and Human Services, determining that a biopharma company's refund program for its cell therapy will not be penalized, indicates an encouraging willingness to engage, but the regulator's assumptions about the program's limited term warrant a closer look, says Mary Kohler at Kohler Health.
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DOJ Innovasis Settlement Offers Lessons On Self-Disclosure
The recent $12 million settlement with Innovasis and two of its executives demonstrates the U.S. Department of Justice's continued prioritization of Anti-Kickback Statute enforcement amid the growing circuit split over causation, and illustrates important nuances surrounding self-disclosure, say Denise Barnes and Scott Gallisdorfer at Bass Berry.
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How Orange Book Antitrust Scrutiny Is Intensifying
Pharmaceutical patent holders should be reviewing Orange Book listing practices, as the Federal Trade Commission takes a more aggressive antitrust approach with actions such as the Teva listing probe, and the U.S. Food and Drug Administration calls attention to potentially improper listings, say attorneys at McDermott.
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After Chevron: Slowing Down AI In Medical Research
The U.S. Supreme Court's recent decision overturning the Chevron doctrine may inhibit agencies' regulatory efforts, potentially slowing down the approval and implementation of artificial intelligence-driven methodologies in medical research, as well as regulators' responses to public health emergencies, say Ragini Acharya and Matthew Deutsch at Husch Blackwell.
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FDA's Multifaceted Role On Display In MDMA Therapy Scrutiny
Ongoing deliberations at the U.S. Food and Drug Administration regarding MDMA-assisted therapy for post-traumatic stress disorder serves as a window into the intricate balance of scientific innovation and patient safety oversight, and offers crucial insights into regulatory nuances, say Kimberly Chew at Husch Blackwell and Kevin Lanzo at Pharmaka Clinical Consulting.
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Analyzing FDA Draft Guidance On Clinical Trial Diversity
In light of the U.S. Food and Drug Administration's draft guidance on clinical trial diversity action plans, there are several important considerations for sponsors and clinical researchers to keep in mind to prevent delay in a drug or device application, say attorneys at Crowell & Moring.
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In The CFPB Playbook: Making Good On Bold Promises
The U.S. Supreme Court's decision upholding the Consumer Financial Protection Bureau's funding structure in the second quarter cleared the way for the bureau to resume a number of high-priority initiatives, and it appears poised to charge ahead in working toward its aggressive preelection agenda, say Andrew Arculin and Paula Vigo Marqués at Blank Rome.
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Critical Questions Remain After High Court's Abortion Rulings
The U.S. Supreme Court's decisions in two major abortion-related cases this term largely preserve the status quo for now, but leave federal preemption, the Comstock Act and in vitro fertilization in limbo, say attorneys at Jenner & Block.