Policy & Compliance
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July 17, 2025
Insurer, Urology Practices Beat Puerto Rico Antitrust Suit
A Puerto Rico federal judge threw out an antitrust lawsuit accusing insurer Triple-S Salud and two urology firms of colluding to exclude rival practices from the commonwealth's government-run healthcare program, finding that the selection of a defendant practice through a competitive process means there was no anticompetitive harm.
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July 17, 2025
Ex-CEO Agrees To $27.5M Judgment In Medicare Fraud Case
A day before his trial was set to begin, the former CEO and owner of the now-defunct laboratory Premier Medical Inc. agreed to a $27.5 million consent judgment, acknowledging he was likely to be found liable in the suit brought against him by the federal government and three states.
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July 17, 2025
Fla. AG, Sandoz Clash With Other Enforcers Over 'Done' Deal
Sandoz and Florida's attorney general pressed a Connecticut federal judge Wednesday to let them settle out of sweeping price-fixing litigation against generic-drug makers, contending that federal civil procedure rules give no room for objections from other state enforcers worried the Sunshine State deal interferes with their own ability to negotiate settlements.
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July 17, 2025
4th Circ. Orders New Trial After Doc Acquitted In Fraud Case
A Fourth Circuit panel ordered a new trial for a doctor who received a judge's acquittal after a jury found him guilty of alleged healthcare fraud, finding that the jury had sufficient evidence to convict, but the case was "close," and the district court was correct in hedging and allowing another shot at the case.
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July 17, 2025
PE Firm Is Denied FDA Docs For Defense In Deal Challenge
An Illinois federal court on Wednesday denied a request from private equity firm GTCR BC Holdings LLC to force the U.S. Food and Drug Administration to produce more than a decade's worth of medical device approval applications as the firm fights a merger challenge from enforcers.
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July 17, 2025
6th Circ. Says Axed Expert Reports Doom Hip Implant Suit
The Sixth Circuit has sided with a medical device maker in a lawsuit brought by a man who alleged a component of his hip implant was faulty due to a manufacturing defect, saying the lower court correctly excluded his experts for their lack of knowledge about the surgery or the company's manufacturing processes.
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July 16, 2025
8th Circ. Sends Part Of OptumRx Pricing Fight To Arbitration
The Eighth Circuit partially reversed a ruling Wednesday that denied pharmacy benefits manager OptumRx's bid to send a drugstore's proposed class action over generics prescription reimbursements to arbitration, finding that OptumRx waived arbitration as to three claims, but an arbitrator must decide the fate of two recently pleaded claims.
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July 16, 2025
Pharmacy Benefit Managers Say Ohio Can't Recast Suit
The state of Ohio can't "recast its complaint on appeal" in order to convince the Sixth Circuit that its enforcement suit accusing two pharmacy benefit managers of working to raise the cost of prescription drugs belongs in state court, those managers have told the appellate court.
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July 16, 2025
Maine Clinics Sue Over Medicaid Ban On Abortion Providers
A Maine family planning organization sued the U.S. Department of Health and Human Services on Wednesday over abortion-related Medicaid restrictions outlined in President Donald Trump's budget act, saying they violate constitutional equal protection rights.
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July 16, 2025
Charity Care Is Not Unconstitutional Taking, NJ Justices Rule
The New Jersey Supreme Court on Wednesday held that a state requirement to treat patients regardless of the patient's ability to pay does not amount to unconstitutional per se or regulatory taking, backing a lower court's decision that dismissed a group of Garden State hospitals' challenge to the requirement.
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July 15, 2025
GTCR Seeks Rival's Sales Data To Counter FTC Challenge
The private equity firm looking to buy medical device coating company Surmodics is seeking Salesforce data from another competitor in the space, saying the information is crucial to showing that the industry will still be competitive if its acquisition is cleared.
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July 15, 2025
Trump Admin Seeks Win In Harvard $2B Funding Freeze Case
The Trump administration urged a Massachusetts federal judge Monday to grant it summary judgment in Harvard University's lawsuit challenging the government's effort to freeze $2.2 billion in funding, arguing the dispute is a contract fight that belongs in the Federal Claims Court and the allegations fail on the merits.
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July 15, 2025
Split 4th Circ. Rejects GenBioPro Abortion Ban Challenge
A split Fourth Circuit panel on Tuesday rejected GenBioPro's challenge to a West Virginia law banning medication abortion with narrow exceptions, with the majority finding the ban does not conflict with federal regulators' statutory authority to impose safety requirements on drug manufacturers.
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July 15, 2025
Medicaid Cuts Pose 'Frontal Assault,' Penn Law Prof Says
Allison K. Hoffman, a health insurance regulation expert at the University of Pennsylvania Carey Law School, talks about the wide-ranging impacts of the cuts coming to Medicaid funding.
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July 15, 2025
Decades After Autism Omnibus, CDC Back In Thimerosal Fight
An unusual legal proceeding two decades ago tested claims that childhood vaccines caused autism. The "omnibus" proceeding found no such link, cutting off the primary legal path for such claims. Today, a CDC advisory panel reconstituted by HHS Secretary Robert F. Kennedy Jr. is reopening the debate.
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July 15, 2025
Wash. Court Doubts Hospitals' Bid To Nix $230M Judgment
A Washington state appellate judge criticized a hospital system's attempt to undo a $230 million loss in a class wage and hour suit on Tuesday, suggesting the employer's arguments about meal break waivers and timekeeping practices are at odds with its own records.
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July 15, 2025
Workers Seek Class Status In United Pricing Scheme Suit
A group of workers urged a California federal judge to award them class certification in their suit alleging United Behavioral Health and a billing contractor shorted them on coverage for out-of-network substance use disorder treatments, arguing they put forward new detail that clears class status requirements.
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July 15, 2025
Amid Budget Woe, New Hampshire Shutters Drug Price Board
Bucking a trend of state efforts to rein in prescription drug prices, New Hampshire lawmakers have dissolved a state drug affordability board launched just five years ago.
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July 15, 2025
Wisconsin Health Co. Faces Trimmed 403(b) Fee Suit
A federal judge agreed to trim a federal benefits lawsuit against a Wisconsin health system from a proposed class of employees who said their 403(b) retirement plan was mismanaged, refusing to dismiss recordkeeping fee claims but agreeing to toss allegations of excessive investment management fees.
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July 15, 2025
A Legal 'Green Light' For FDA Abortion Drug Review
A case brought by Democratic attorneys general led to a "green light" federal court decision for the Trump administration as it considers new regulations on the abortion drug mifepristone.
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July 14, 2025
BCBS Defends $2.8B Provider Antitrust Deal Amid Objections
Blue Cross Blue Shield asked an Alabama federal judge on Friday to approve a $2.8 billion antitrust settlement with hospitals and other healthcare providers over its territorial policies, arguing that recent objections to the deal's release provision are meritless and the settlement preserves "key, procompetitive features" of the insurance system.
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July 14, 2025
CFPB Deal To Put Medical Debt Back On Reports OK'd
A Texas federal court has reversed a Biden-era rule that kept an estimated $49 billion in medical debt from credit reports after the Consumer Financial Protection Bureau and lender trade groups struck a deal to axe the rule.
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July 14, 2025
DOJ Drops Vax Card Case Against Plastic Surgeon Mid-Trial
The Justice Department dismissed charges against a Utah plastic surgeon accused of leading a conspiracy to forge COVID-19 vaccination cards for over 1,500 people, ending the case less than a week after trial began in Salt Lake City federal court.
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July 14, 2025
Cigna Denies Responsibility For Alleged Health Data Breach
Cigna has asked a Pennsylvania federal judge to throw out class claims by health plan members alleging it failed to protect their private data, arguing they didn't show how their sensitive information was intercepted from the insurer's websites.
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July 14, 2025
Court Says Insider Trading Rules Unscathed By Loper Bright
A U.S. Supreme Court ruling that curtailed deference to agency interpretations of law did not undermine the U.S. Securities and Exchange Commission's rules against insider trading, a Pennsylvania federal court ruled Friday.
Expert Analysis
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7 Considerations For Conducting Drug Clinical Trials Abroad
With continuing cuts to U.S. Food and Drug Administration staffing motivating some pharmaceutical companies to consider developing drugs abroad, it's important to understand the additional risks and compliance requirements associated with conducting clinical studies in other countries, say attorneys at Morgan Lewis.
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Compliance Lessons From Warby Parker's HIPAA Fine
The U.S. Department of Health and Human Services' civil money penalty against Warby Parker highlights the emerging challenges that consumer-facing brands encounter when expanding into healthcare-adjacent sectors, with Health Insurance Portability and Accountability Act compliance being a potential focus of regulatory attention, say attorneys at Saul Ewing.
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5th Circ. Ruling Is Latest Signal Of Shaky Qui Tam Landscape
In his recent concurring opinion in U.S. v. Peripheral Vascular Associates, a Fifth Circuit judge joined a growing list of jurists suggesting that the False Claims Act's whistleblower provisions are unconstitutional, underscoring that acceptance of qui tam relators can no longer be taken for granted, say attorneys at Miller & Chevalier.
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Medicare Advantage Enforcement Strong Amid Agency Cuts
The second Trump administration's actions thus far suggest that Medicare Advantage enforcement remains a bipartisan focus despite challenges presented by evolving trends in federal agency staffing and resources, say attorneys at Ropes & Gray.
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A New Tool For Assessing Kickback Risks In Health Marketing
The Seventh Circuit's recent decision in U.S. v. Sorensen, reversing a conviction after trial of a durable medical equipment distributor, highlights two principle considerations for determining whether payments to marketers in healthcare are unlawful under the Anti-Kickback Statute, says Elisha Kobre at Sheppard Mullin.
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How Trump Orders Affect Health Orgs.' Care For Trans Minors
Two recent executive orders issued by President Donald Trump regarding gender-affirming care for minors have put healthcare organizations in a precarious situation, and these institutions should prepare for various implications and potential scenarios, say attorneys at ArentFox.
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Reproductive Health Under Trump So Far, And What's Next
Based on priorities stated so far, the Trump administration will likely continue to weaken Biden-era policies that protect reproductive health, with abortion, in vitro fertilization and contraception all being issues to watch closely amid a post-Dobbs shift, say attorneys at McDermott.
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What's Next For Lab Test Regulation Without FDA Authority
A recent Texas federal court decision vacating the U.S. Food and Drug Administration's final rule that would apply FDA regulations to laboratory-developed tests signals potential positive impacts in the diagnostic space, and could inspire more healthcare entities to litigate against the government, say attorneys at Hooper Lundy.
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6 Criteria Can Help Assess Executive Branch Actions
With new executive policy changes announced seemingly every day, several questions can help courts, policymakers and businesses determine whether such actions are proper, effective and in keeping with our democratic norms, say Marc Levin and Khalil Cumberbatch at the Council on Criminal Justice.
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Learning From COVID-19 Enforcement Against Nursing Homes
Five years after the COVID-19 outbreak caused a high number of deaths in nursing homes, an examination of enforcement actions against nursing homes in New York and elsewhere in the country highlights obstacles that may arise when bringing cases of this type, and ways to overcome them, says Kenneth Levine at Stone & Magnanini.
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How Plan Sponsors Can Mitigate Risk In PBM Contracts
A recent lawsuit in New York federal court alleges that JPMorgan caused exorbitant prescription costs by mishandling the pharmacy benefit manager arrangement, adding to a growing body of Employee Retirement Income Security Act fiduciary breach litigation and affirming that fiduciaries must proactively manage their healthcare plan vendors, say attorneys at Hall Benefits Law.
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4th Circ. Health Data Ruling Opens Door To State Law Claims
In Real Time Medical v. PointClickCare, the Fourth Circuit recently clarified that state law claims can rest in part on violations of a federal law that prohibits electronic health information blocking, expanding legal risks for health IT companies and potentially creating exposure to a range of competitive implications, say attorneys at BCLP.
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Unpacking Trump Admin Plans For Value-Based Care
Recent developments from the Center for Medicare and Medicaid Innovation suggest the Trump administration intends to put its own stamp on value-based care, emphasizing cost savings assessment in particular, with its recent cancellation of several payment models that had supported primary care, says Miranda Franco at Holland & Knight.