Policy & Compliance
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November 20, 2025
Pharma Cos. Seek Early Win In States' Price-Fixing Lawsuit
A collection of states failed to prove an overarching conspiracy among 25 separate pharmaceutical companies to fix the prices of generic drugs, most of them dermatology formulations, the drugmakers argued Wednesday in support of a bid for an early win on one element of dozens of antitrust claims.
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November 20, 2025
5th Circ. Seeks Interpretation Of Miss. Health Decisions Law
A Fifth Circuit panel asked the Mississippi Supreme Court on Thursday to clarify an "ambiguous" state law that sets out which family members can act as surrogates and make healthcare decisions for relatives without the capacity to decide for themselves.
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November 20, 2025
Ala. County Must Face Inmate Death Claim, 11th Circ. Rules
An Eleventh Circuit panel ruled Thursday that no Alabama state law prevents a county from facing liability for an incarcerated person's death after substandard healthcare from a third-party medical provider the county hired.
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November 20, 2025
Blue Shield Of California, Magellan Sued Over 'Ghost Network'
Blue Shield of California and Magellan Health maintain a "ghost network" directory of mental health providers who don't exist or don't accept new patients, leading customers to hit a dead end or desperately resort to expensive out-of-network providers, according to a proposed class action filed Wednesday in California federal court.
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November 20, 2025
10th Circ. Weighs Colo. Law On Healthcare Sharing Plans
A Tenth Circuit panel grappled Thursday with how the court should interpret a Colorado law requiring entities not authorized to offer insurance in the state to report certain information about their healthcare sharing plans, in an appeal by a religious trade group challenging the law's constitutionality.
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November 20, 2025
Claims Firms Barred From Misleading Plaintiffs In Pharma MDL
On the same day that a Philadelphia federal judge approved $58 million in settlements as part of an ongoing generic-drug price-fixing multidistrict litigation, she also ordered several claims recovery firms to correct allegedly false and misleading ads used to attract potential clients seeking to make claims on the settlements.
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November 19, 2025
Senior Living Co. Inks $7.2M Deal To End Wash. AG's Probe
Oregon-based senior living provider Bonaventure will invest $7 million in staffing and upgrades and shell out $200,000 in resident credits to resolve allegations of substandard care at 10 Washington state facilities, under a settlement filed Wednesday.
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November 19, 2025
Is 'Red Book' Best For Drug Pricing? Pa. Justices Ask
The Pennsylvania Supreme Court seemed skeptical Wednesday that the state workers' compensation authorities were using the best guide to calculate pharmacy reimbursements for injured workers' prescription drugs, with the justices questioning the fairness of the industry's long-used "red book" method.
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November 19, 2025
11th Circ. Backs Kaiser In Air Ambulance Arbitration Dispute
The Eleventh Circuit on Wednesday declined an air ambulance company's bid to scrap an arbitrator's ruling that Kaiser only owes $24,000 for an emergency helicopter flight, rejecting the emergency medical provider's arguments that the insurer committed fraud by strategically lowballing the arbitrator.
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November 19, 2025
Aetna Gets OK For $3.4M Deal In Cancer Treatment Denial Suit
A Florida federal judge has signed off on Aetna's $3.4 million settlement agreement resolving a class action that alleged the insurer unlawfully mischaracterized a proton beam cancer radiation treatment as experimental to deny dozens of claims.
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November 19, 2025
Senate GOP Resists Extending Expanded ACA Tax Premiums
Senate Finance Committee Democrats on Wednesday urged their Republican counterparts to extend the enhanced tax credits for the Affordable Care Act, which is set to expire at the end of the year, but Republicans said they were looking for other options to address rising healthcare costs.
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November 19, 2025
Conn. Dentists Pay $714K To Settle Patient Kickback Claims
Two Connecticut dentists will pay more than $714,000 to the state and federal governments to settle joint allegations that their practices submitted false government benefits claims that contained kickbacks for patient recruiters.
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November 19, 2025
Pa. Health Network's $1.15M 401(k) Suit Deal Gets Initial OK
A healthcare system Wednesday secured initial approval from a Pennsylvania federal court for a $1.15 million settlement agreement that would resolve a proposed class action alleging the company misused forfeited retirement plan funds and allowed the plan's administrative costs to soar.
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November 19, 2025
Whoop Blood Pressure Tracker Hit With False Ad Suit
A consumer on Tuesday hit health and wellness wearable tech company Whoop Inc. with a proposed class action in California federal court alleging that its boasting of the blood pressure features of its fitness tracker duped consumers and prompted a warning from health regulators.
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November 19, 2025
Hospice Co. Should Face Tobacco Fee Suit, Judge Says
A hospice and home healthcare provider shouldn't escape a proposed class action challenging a tobacco surcharge in its employee health plan, a Pennsylvania federal judge recommended, finding that allegations sufficiently backed up that a wellness program implementing the fee didn't meet all regulatory requirements.
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November 19, 2025
Doctor, Husband Admit $16M Healthcare Fraud, Tax Evasion
A physician and her husband admitted to committing more than $16 million in healthcare fraud and tax evasion as part of a scheme that injected sick patients with the wrong medications or dosages, according to their plea agreements in Alaska federal court.
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November 19, 2025
COVID-19 Testing Co. Settles Wage Suit With Testers, Drivers
A COVID-19 mobile testing company told a New York federal court that it has reached a settlement with a group of testers and drivers who claimed they were not paid full wages and overtime.
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November 19, 2025
Doc Takes Plea, Avoids Prison In Novel Opioid Death Case
A retired Massachusetts doctor pled guilty and was sentenced to five years of probation in a first-of-its-kind involuntary manslaughter case over a patient's 2016 opioid overdose death, the state attorney general's office announced.
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November 18, 2025
Health Co. Execs Convicted In $100M Adderall Sales Scheme
A San Francisco federal jury weighing a first-of-its-kind case on Tuesday convicted two digital healthcare company executives of scheming to sell Adderall through deceptive advertising, allegedly bringing in $100 million in illicit profits.
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November 18, 2025
'Surrender' Note Warrants Med Mal Retrial, Ill. Justices Hear
A below-the-knee amputee who lost his medical malpractice trial urged the Illinois Supreme Court to order a retrial in his case Tuesday, arguing a note stating a juror sided with the defense simply to end deliberations proves the verdict was not unanimous.
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November 18, 2025
Severe SC Abortion Bill Falters in Committee
A South Carolina bill that would have further criminalized abortion and subjected patients and doctors to up to 30 years in prison failed to advance out of a Senate committee on Tuesday, with antiabortion committee members raising concerns that the bill went too far.
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November 18, 2025
Feds Say Hi-Tech 'Trampled' Trust At Close Of Fraud Trial
Federal prosecutors closed out a nearly monthlong fraud trial against Hi-Tech Pharmaceuticals and its longtime CEO by telling a Georgia jury Tuesday that they "proudly" stood by what defense attorneys for the supplement manufacturer and distributor previously derided as a "paper case."
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November 18, 2025
Bristol-Myers Squibb Can Appeal Pension Suit To 2nd Circ.
Drugmaker Bristol-Myers Squibb and its investment manager can ask the Second Circuit to review a decision from September denying their motion to dismiss a pension dispute for lack of standing, a New York federal judge ruled.
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November 18, 2025
1st Circ. May Nix Trump Funding Freeze In 'Weird' Case
The First Circuit on Tuesday hinted that a federal judge may have been in bounds when blocking the Trump administration from withholding certain funds for states, expressing skepticism that the judge's order was improper or overly broad.
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November 18, 2025
Mass. Health Co. Settles 401(k) Suit Over Pricey Fees, Funds
A Cambridge hospital system agreed to settle a proposed class action claiming it mismanaged its $280 million retirement plan and cost workers millions in savings by failing to reduce management fees and trim costly funds from the plan, according to a Massachusetts federal court filing.
Expert Analysis
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What To Expect From 'Make America Healthy Again' Actions
The Make America Healthy Again Commission recently established by President Donald Trump and chaired by Robert F. Kennedy Jr. will potentially bring energy and attention to important public health topics, and stakeholders should be aware of pathways for sharing their input and proactively informing proceedings, says Nicholas Manetto at Faegre Drinker.
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How Citizen Petitions Have Affected Drug Competition
In light of recent citizen petitions and proposed legislation regulating such petitions, Omar Robles at Managing Health analyzes the statistics of the extent to which citizen petitions have been filed, and to what extent they have delayed competition in prescription pharmaceuticals.
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Drug Kickback Ruling Will Make FCA Liability Harder To Prove
The First Circuit's ruling in U.S. v. Regeneron Pharmaceuticals, requiring the government to prove but-for causation to establish False Claims Act liability based on violations of the Anti-Kickback Statute, raises the bar for FCA enforcement and deepens a circuit split that the U.S. Supreme Court may need to resolve, say attorneys at Baker Donelson.
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Assessing PE Risk After Mass. False Claims Act Amendments
A law recently passed in Massachusetts amends the commonwealth's False Claims Act by dramatically expanding potential liability for private equity firms and investors, underscoring the importance of robust diligence and risk assessments for private equity firms conducting transactions in the commonwealth, say attorneys at Gibson Dunn.
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What Trump Actions Mean For Federal Research Funding
New guidance from the National Institutes of Health represents a massive policy shift regarding federal funding for researchers at institutions of higher education, contributing to a perfect storm of significant resource shortfalls in upcoming years, say attorneys at Arnold & Porter.
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A Look At Healthcare Transaction Oversight In Oregon
Understanding Oregon's enforcement authority and its impact on proposed transactions last year provides a road map to the state's plans to strengthen its processes this year, though enforcement could be challenged by ongoing litigation, say attorneys at Ropes & Gray.
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Rethinking 'No Comment' For Clients Facing Public Crises
“No comment” is no longer a cost-free or even a viable public communications strategy for companies in crisis, and counsel must tailor their guidance based on a variety of competing factors to help clients emerge successfully, says Robert Bowers at Moore & Van Allen.
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High Court Must Acknowledge US History Of Anti-Trans Laws
Despite Justice Amy Coney Barrett's claim to the contrary during oral arguments in U.S. v. Skrmetti, U.S. governments at every level have systematically discriminated against transgender people, and the U.S. Supreme Court must consider this historical context in upcoming cases about transgender issues, says Paisley Currah at the City University of New York.
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The Fate Of Biden-Era Clinical Study Guidance Under Trump
Draft guidance about the study of sex and gender differences in medical product development issued by the outgoing Biden administration currently faces significant uncertainty and litigation potential due to the Trump administration's executive orders and other actions, say attorneys at Arnold & Porter.
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10 Issues To Watch In Aerospace And Defense Contracting
This year, in addition to evergreen developments driven by national security priorities, disruptive new technologies and competition with rival powers, federal contractors will see significant disruptions driven by the new administration’s efforts to reduce government spending, regulation and the size of the federal workforce, say attorneys at Thompson Hine.
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Dispelling 10 Myths About Health Provider-Based Compliance
Congress appears intent on requiring hospitals to submit provider-based attestations for all off-campus outpatient hospital locations, so now is the time for hospitals to prepare for this change by understanding common misconceptions about provider-based status and proactively correct noncompliance, say attorneys at McDermott.
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A Look At HHS' New Opinion On Patient Assistance Programs
A recent advisory opinion from the U.S. Department of Health and Human Services' Office of Inspector General follows a recent trend of blessing patient assistance program arrangements that implicate the Anti-Kickback Statute, as long as they are structured with appropriate safeguards to minimize the risk of fraud and abuse, say attorneys at Sheppard Mullin.
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2 Anti-Kickback Developments Hold Lessons For Biopharma
The U.S. Department of Justice's Anti-Kickback Statute settlement with QOL Medical and a favorable advisory opinion from the U.S. Department of Health and Human Services provide a study in contrasts, but there are tips for biopharma manufacturers trying to navigate the vast compliance space between them, says Mary Kohler at Kohler Health Law.