Policy & Compliance
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September 23, 2024
Aetna ER Payment Suit Remanded To Ohio State Court
An Ohio federal judge remanded a suit accusing multiple Aetna health insurance entities of underpaying healthcare workers for emergency services they provide to its insureds to state court, stating that to resolve the claims in his own court "would disrupt the state-federal balance of judicial responsibilities."
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September 20, 2024
Arbitration Unlikely For Nursing Home Poison Death Suit
A California state appeals court has all but affirmed the denial of arbitration in a suit alleging a nursing home caused the poisoning death of a resident who was mistakenly served industrial cleaner left in a pitcher, saying the trial court must first review the validity of the arbitration agreement.
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September 20, 2024
5th Circ. Deals Biden A Loss in Medicare Drug Pricing Row
A Fifth Circuit panel majority said that a healthcare trade association has standing to challenge the Biden administration's Medicare drug pricing program, allowing the group to sidestep agency administrative procedure and test its claims in federal court.
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September 20, 2024
3 Atty Takeaways On Mental Health Parity Final Rules
Federal agencies' recently finalized rules for how employer health plans must analyze their coverage of mental health and substance use disorder treatments imposes significant new reporting and disclosure requirements, although regulators backed off more sweeping proposed network design changes. Here are attorneys' three key takeaways from the final mental health parity rules — what made it in, what's out and what to watch for next.
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September 20, 2024
Green Groups Can't Bar Housing Project, SC Judge Says
A South Carolina federal judge on Thursday denied conservation groups' push to block a 9,000-unit housing development on the Cainhoy Peninsula near Charleston, ruling they've not shown they're likely to succeed in a case challenging federal reviews and approvals.
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September 20, 2024
FTC Accuses Drug Middlemen Of Raising Insulin Prices
The Federal Trade Commission on Friday accused the three largest pharmacy benefits managers, Caremark Rx, Express Scripts and OptumRx, of artificially inflating insulin prices by relying on unfair rebate schemes that hurt competition.
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September 19, 2024
Ga. Appeals Court Says Hospital Must Get Certificate Of Need
The Georgia Court of Appeals for the second time has said that a Georgia hospital must obtain a new certificate of need from the state to convert its long-term care beds to short-stay acute care beds, following guidance issued by the state's justices earlier this year.
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September 19, 2024
Teamsters Unit Escapes Hospital Worker's Wage Suit
A Massachusetts federal judge tossed a hospital worker's claims that a Teamsters unit failed to properly represent her when she didn't receive as big a pay bump under a new collective bargaining agreement as expected, saying the union showed it did what it could to advocate for her.
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September 18, 2024
7th Circ. Questions Nixing $183M Eli Lilly Drug Rebate Verdict
A Seventh Circuit judge seemed unsure Wednesday whether to disturb a $183 million verdict against Eli Lilly in a false claims case targeting more than a decade of drug rebate miscalculations, questioning whether the company skipped checking legal guidance before calling its price reporting requirements unclear.
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September 18, 2024
Health AI Co. Says Texas AG 'Misrepresents' Compliance Deal
The Texas attorney general's Wednesday announcement of a compliance agreement with a healthcare-focused artificial intelligence company has sparked backlash from the company, which accused the state prosecutor of "dangerously" misrepresenting their agreement.
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September 18, 2024
Ex-Amgen Rep Wasn't Original Whistleblower, Judge Says
A Brooklyn federal judge tossed a former Amgen sales representative's whistleblower suit on Wednesday, saying many elements of his allegations of a kickback scheme had been disclosed in news reports and civil lawsuits prior to his filing.
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September 17, 2024
North Carolina Panel Orders Redo In Hospital Beds Battle
A Tar Heel State administrative court erred when it used the state health department's failure to hold a public hearing as a basis to yank the department's approval of the University of North Carolina's application to enhance its hospital's services, an appeals court ruled Tuesday, in a setback for Duke University's healthcare unit.
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September 17, 2024
Texas Fertility Clinic Hid 'Catastrophic' Lab Issue, Couples Say
Five couples accused a Houston fertility institute of hiding "catastrophic" laboratory issues that affected patients' embryos, saying in a lawsuit that the entity instead injected multiple hopeful mothers with "dead or dying" eggs.
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September 17, 2024
Henrietta Lacks' Family Still Seeks Justice For 'Immortal' Cells
Seven decades have passed since a doctor at a Baltimore hospital took, without permission, a sample of cells from a Black woman suffering from cervical cancer. While the durable strain of human cells known as "HeLa" has fueled a handful of lawsuits against drug companies accused of profiting from stolen genetic material, more are likely on the way.
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September 17, 2024
Brooklyn Feds Unveil Whistleblower Nonprosecution Plan
The Brooklyn U.S. Attorney's Office on Tuesday announced an initiative to reward corporate whistleblowers with nonprosecution deals amid a broader effort by federal prosecutors to encourage voluntary disclosure of criminal activity.
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September 17, 2024
Express Scripts Blasts 'Biased' FTC Drug Middlemen Report
The Federal Trade Commission defamed Express Scripts and violated its constitutional rights with an inaccurate report that ripped the role pharmacy benefit managers play as middlemen between drugmakers and insurers, according to a lawsuit lodged Tuesday in Missouri federal court.
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September 17, 2024
Blumenauer Pushes House Speaker To Put Pot Bill To Vote
U.S. Rep. Earl Blumenauer, D-Ore., on Monday urged House Speaker Mike Johnson to bring bipartisan cannabis legislation to a vote following revelations that Richard Nixon admitted privately that marijuana was "not particularly dangerous" while he publicly waged the war on drugs.
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September 16, 2024
5th Circ. Judge Chides High Court Calls in Abortion Pill Case
U.S. Circuit Judge James C. Ho on Monday threw shade at the U.S. Supreme Court and the Biden administration over what he described as side-switching on federal conscience laws for doctors.
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September 16, 2024
NC High Court Snapshot: Tax Fights And A Health Care Spat
Regulatory battles will take center stage when the North Carolina Supreme Court returns from summer break this week for a September argument lineup featuring appeals by Phillip Morris, Duke University's hospital and two Boost Mobile dealers.
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September 16, 2024
Nebraska Medical Cannabis Initiatives Will Be On Nov. Ballot
Initiatives to legalize medical marijuana in Nebraska will appear on the ballot come November, despite some evidence of fraud in the signature-collecting petition process, according to state election officials.
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September 13, 2024
The 2024 Regional Powerhouses
The law firms on Law360's list of 2024 Regional Powerhouses reflected the local peculiarities of their states while often representing clients in deals and cases that captured national attention.
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September 13, 2024
Doctor Charged In DOJ Fraud Suit Gets 6 Months Probation
One of the defendants accused in a healthcare fraud suit that ended in a mistrial in 2022 was sentenced Thursday to six months of probation after pleading guilty in June to one count of aiding and abetting the conversion of public money in connection with the alleged fraud.
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September 13, 2024
Neb. Court Allows Competing Abortion Measures On Ballot
Nebraska's top court agreed on Friday to let two competing — and sharply contested — abortion initiatives on the November ballot.
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September 13, 2024
Mass. Justices Say Benefits Don't Accrue Under Leave Law
Massachusetts' top court ruled Friday that the state's Paid Family and Medical Leave Act doesn't allow a group of state troopers to accrue certain benefits while on leave.
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September 12, 2024
ND Judge Finds 'Fundamental Right' To Abortion, Strikes Ban
Women in North Dakota have a "fundamental right" to abortion access pre-viability, a state judge ruled Thursday in a decision overturning a near-total state ban.
Expert Analysis
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A Primer On EU's Updated Human Substance Regulations
The European Union's updated standards regarding quality and safety of substances of human origin meant for human application carry significant implications for companies that work with cells and tissues, and U.S. companies active in the EU market should pay particular attention to the import and export rules, say Geneviève Michaux and Georgios Symeonidis at King & Spalding.
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CFPB's Medical Debt Proposal May Have Side Effects
The Consumer Financial Protection Bureau’s recent proposal to prevent medical debt information from appearing on consumer reports and creditors from basing lending decisions on such information may have initial benefits for some consumers, but there are potential negative consequences that should also be considered, say attorneys at Cooley.
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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.