Policy & Compliance
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April 18, 2025
Mass General Inks $8.25M Deal To End Retirement Fee Suit
Boston-based healthcare system Mass General Brigham Inc. agreed to pay $8.25 million to settle a proposed class action alleging it unlawfully allowed its employee retirement plan to pay excessive administrative fees, according to a filing in Massachusetts federal court.
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April 17, 2025
Incyte Can Get Novartis' Privileged Info On Drug Royalty Deal
Novartis must produce certain privileged documents to Incyte concerning its understanding of their contract for royalty payments from sales of Incyte's blood cancer drug, unless Novartis agrees its former outside counsel, who negotiated the terms, won't testify about that topic at the upcoming contract breach trial, a New York federal judge said Thursday.
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April 17, 2025
RI Judge Wants To Know Who's Behind $11B Health Grant Cuts
A Rhode Island federal judge on Thursday pressed the Trump administration for details about the decision-makers behind the cancellation of billions in grants supporting state public health programs.
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April 17, 2025
Arkansas Bans PBMs From Owning Pharmacies
Pharmacy benefit managers operating in Arkansas will soon be prohibited from owning pharmacies in the state after Gov. Sarah Huckabee Sanders signed a bill that lawmakers say is meant to minimize conflicts of interest and safeguard patients.
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April 17, 2025
Tenet Asks Court To Enforce Dead Arbitrator's $546K Award
Tenet Healthcare Corp. has asked a Washington, D.C., federal judge to require the Service Employees International Union to follow an arbitrator's final order to pay $546,000 after making derogatory statements, despite the arbitrator dying before ruling on the union's post-judgment reconsideration motion.
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April 17, 2025
AFL-CIO, Unions Can Pursue Some DOGE Access Claims
The AFL-CIO, unions and advocacy groups may pursue allegations that Elon Musk's Department of Government Efficiency lacks the power to access data from the U.S. Department of Labor and other federal agencies, a D.C. federal judge ruled while tossing some claims under federal administrative and privacy law.
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April 17, 2025
3rd Circ. Questions Walmart's Duty To Disclose Opioid Probe
The Third Circuit on Thursday questioned the extent to which Walmart knew of the government's interest in prosecuting it for opioid sales, as it considered a bid by investors to revive class claims alleging the retail chain failed to disclose it was under investigation.
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April 16, 2025
Wyo. Justices Skeptical Of State Abortion Bans' Legality
The Wyoming Supreme Court on Wednesday seemed poised to side with a lower court judge that recent abortion bans violate the state's constitution, hinting that the Legislature doesn't have the authority to determine when life begins and thus cannot establish a compelling interest for the laws.Â
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April 16, 2025
UnitedHealthcare Owes $1M Medicare Shortfall, Hospital Says
UnitedHealthcare owes Connecticut's Danbury Hospital more than $1 million after bungling local Medicare Advantage cost calculations and refusing to correct its payment errors after the hospital provided notice of the problem, the healthcare facility alleged in a state court lawsuit.
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April 15, 2025
DC Asks Judge To Narrow Nursing Home Ruling
The District of Columbia urged a D.C. federal judge on Tuesday to narrow an injunction requiring it to do more to help disabled nursing home residents transition into the community, arguing the order reaches beyond the class of plaintiffs and is too vague.
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April 15, 2025
Food Service Co. Can't Escape Tobacco Surcharge Suit
A food service company can't dodge a proposed class action alleging it unlawfully charges tobacco users an additional fee to obtain health insurance, an Illinois federal judge ruled Tuesday, rejecting the company's assertion that federal benefits law doesn't require retroactive reimbursement for completing a cessation program.
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April 15, 2025
FDA Drug Rules Under Fire in Pharma Free Speech Fight
Vanda Pharmaceuticals says it spent years establishing that one of its flagship, FDA-approved products is an effective and safe treatment for jet lag. But after being denied agency approval for that use, the company launched a novel First Amendment challenge meant to dismantle federal rules for “off-label” drug promotion.
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April 15, 2025
39 AGs Urge Congress To Ban PBM Pharmacy Ownership
A bipartisan coalition of attorneys general have urged congressional leadership to pass legislation banning pharmacy benefit managers, their parent companies and affiliates from owning and operating pharmacies in order to boost competition and fairness.
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April 15, 2025
UBH Can't Nix Class Status In Coverage Guidelines Suit
United Behavioral Health can't unwind class certification in a lawsuit claiming it unlawfully imposed overly restrictive guidelines for coverage of residential mental health treatments, a California federal judge ruled, saying the group's parameters could be adjusted to meet a recent Ninth Circuit standard.
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April 15, 2025
Anthem Strikes Deal To End Mental Health Class Action
Anthem agreed to settle a class action from participants in employee health plans the insurer administered who alleged that coverage denials for inpatient mental health and substance use disorder treatments violated federal benefits and metal health parity laws, the parties told a New York federal court Tuesday.
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April 15, 2025
Minn. Couple Accused Of $15M Healthcare Fraud Scheme
A Minnesota couple whose company was hit with a default civil judgment last year now face an indictment alleging they carried out a $15 million scheme to defraud Medicare, Medicaid and insurance companies by overbilling for neurofeedback therapy and other medical services.
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April 15, 2025
Legislation Roundup: States Consider Slew Of Abortion Bills
Nearly three years after the U.S. Supreme Court's Dobbs decision upended federal abortion access protection, dozens of abortion-related bills are moving through state legislatures this year.
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April 15, 2025
Ga. Woman Says Baby 'Ripped Away' After Embryo Mix-Up
A South Carolina fertility clinic has been hit with a lawsuit from a former patient alleging that its doctors placed the wrong embryo inside her — a fact she discovered only when she, a white woman, gave birth to a Black boy — only to have the baby "ripped away from her" by his biological parents after months of raising him as her own.
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April 15, 2025
McGuireWoods Immune From Defamation Case, NC Panel Told
McGuireWoods LLP and a former partner have told a North Carolina state appeals court that they have absolute privilege over allegedly defamatory statements made in connection with an investigation into the former CEO of a managed care organization, arguing that the trial court should have granted them a pretrial win.
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April 15, 2025
Pa. Man To Plead Guilty In Harvard Body Parts Theft Case
A Pennsylvania man will plead guilty to a federal charge for transporting body parts that were allegedly stolen from cadavers by the manager of Harvard Medical School's morgue, according to a Tuesday filing.
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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.
Expert Analysis
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Weak Reasoning Underlies Fla. Judge's Bold Qui Tam Ruling
U.S. District Judge Kathryn Mizelle's groundbreaking decision in U.S. ex rel. Zafirov v. Florida Medical Associates LLC, holding that qui tam provisions of the False Claims Act are unconstitutional, relies on weak logic to reach a conclusion that differs from every other court that has ruled on the issue, says Ethan Greenberg at Anderson Kill.
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Medicare Overpayment Rules Are A Mixed Bag For Providers
The Centers for Medicare & Medicaid Services' updated rules for handling agency overpayments adopt a more reasonable definition of what it means to have "identified" an overpayment, which is a win for providers, but their new time frame for investigating related overpayments is unrealistic, says Susan Banks at Holland & Knight.
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Expect More State-Level Scrutiny Of Noncompetes Ahead
Despite the nationwide injunction against the Federal Trade Commission’s noncompete ban, and the incoming Republican administration, employers should anticipate that state legislatures will continue to focus on laws that limit or ban noncompetes, including those that target certain salary thresholds or industries, says Benjamin Fryer at FordHarrison.
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Cos. Should Inventory Issues To Prep For New Congress
As the legislative and oversight agendas of the 119th Congress come into sharper focus, corporate counsel should assess and plan for areas of potential oversight risk — from tax policy changes to supply chain integrity — even as much uncertainty remains, say attorneys at WilmerHale.
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Incoming Admin May Shake Up Life Sciences Regulation
Though President-elect Donald Trump has not yet articulated policy priorities regarding the life sciences industry, the sector is positioned to see significant changes that could affect everything from drug exclusivity and generic drug approvals, to the availability of over-the-counter drugs, to laboratory-developed tests and digital health, say attorneys at Morgan Lewis.
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Navigating DOJ's Patchwork Whistleblower Regime
In the past few months, the U.S. Department of Justice and several individual U.S. attorney’s offices have issued different pilot programs aimed at incentivizing individuals to blow the whistle on misconduct, but this piecemeal approach may create confusion and suboptimal outcomes, say attorneys at BakerHostetler.
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What To Expect Next From Federal Health Tech Regulation
Healthcare organizations should pay close attention to federal health information technology regulators' recent guidance concerning barriers to accessing electronic health information, which signals that more enforcement in this area is likely forthcoming, say attorneys at Ropes & Gray.
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5 Areas Congress May Investigate After GOP Election Wins
With Republicans poised to take control of Congress in addition to the executive branch next year, private companies can expect an unprecedented uptick in congressional investigations focused on five key areas, including cryptocurrency and healthcare, say attorneys at Cahill Gordon.
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Takeaways From State Votes On Abortion In The 2024 Election
Attorneys at Epstein Becker discuss how 10 states voted on ballot initiatives to either protect or restrict access to abortion in the 2024 general election, and analyze overarching trends.
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Loper Bright Offers New Materiality Defense To FCA Liability
The U.S. Supreme Court's decision in Loper Bight Enterprises v. Raimondo, ending Chevron deference, may have created a new defense to False Claims Act liability by providing the opportunity to argue that a given regulation is not material to the government's payment decision, says Tanner Cook at Husch Blackwell.
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How Expanded Birth Control Coverage May Affect Employers
Employers should consider the potential impact of recently proposed regulations that would expand group health plans' required coverage of preventive services and contraceptives, including questions about how the agencies would implement their plans to eliminate the prescription requirement and alter the exceptions process, says Jennifer Rigterink at Proskauer.
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Legislation Most Likely To Pass In Lame Duck Session
As Congress begins its five-week post-election lame duck session, attorneys at Greenberg Traurig break down the legislative priorities and which proposals can be expected to pass.
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Preserving The FCA Is Crucial In Trump's 2nd Term
While the Trump administration may pursue weaker False Claims Act enforcement, it remains an essential tool in safeguarding public funds and maintaining corporate accountability, so now is not the time to undermine ethical behavior, or reduce protections and incentives for whistleblowers, says Adam Pollock at Pollock Cohen.