Policy & Compliance
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April 19, 2025
Up Next At High Court: Preventive HealthCare & LGBTQ Books
The U.S. Supreme Court will hear arguments in five cases this week, including disputes over the constitutionality of a task force that sets preventative healthcare coverage requirements, a school district's introduction of LGBTQ-themed storybooks and whether parties can establish standing based on harms affecting third parties.聽
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April 18, 2025
Walgreens To Pay DOJ $300M Over Invalid Prescriptions
Walgreens revealed in a U.S. Securities and Exchange Commission filing Friday that it will pay upward of $300 million to resolve U.S. Department of Justice allegations that it knowingly filed millions of prescriptions for opioids and other drugs that didn't have a legitimate medical purpose or weren't valid.
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April 18, 2025
Lilly Blasts Compounders' 'Scattershot' Bid To Reverse FDA
Eli Lilly urged a Texas federal judge Thursday to deny a request from pharmacies that produce copycat doses of its popular weight loss drug to have the court reverse an FDA decision taking the drug off a national shortage list, saying the bid was filled with unreliable "scattershot" arguments.
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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聽on Wednesday seemed poised to side with a lower court judge that recent abortion bans violate the state's constitution,聽hinting that the Legislature doesn't have the authority聽to determine when life begins and thus cannot establish a compelling interest for the laws.聽
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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 鈥渙ff-label鈥 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 鈥 a fact she discovered only when she, a white woman, gave birth to a Black boy 鈥 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聽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
Abortion Bans At Wyo. High Court: 3 Things To Know
Wyoming鈥檚 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.

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.

Enforcement Delays Ahead Amid HHS Regional Closures
The Trump administration's overhaul of the U.S. Department of Health and Human Services' in-house legal team is likely to slow enforcement proceedings and other compliance activities involving Medicare providers.

Unnecessary Surgeries Drive Rare Va. Hospital Criminal Case
An unusual indictment in Virginia details grave allegations against a former doctor, including unnecessary surgeries and bogus cancer diagnoses. With former OB-GYN Javaid Perwaiz already in federal prison, the hospital where many of the procedures occurred is now facing criminal charges.
Expert Analysis
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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.
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What To Expect For Stem Cell Regulation Under Trump Admin
The new administration's push for deregulation, plus the post-Chevron legal landscape, and momentum from key political and industry players to facilitate stem cell innovation may create an opportune backdrop for a significant reduction in the U.S. Food and Drug Administration's regulatory framework for stem cells, say attorneys at Sheppard Mullin.
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How Importers Can Minimize FCA Risks Of Tariff Mitigation
False Claims Act risks are inherent in many tariff mitigation strategies, making it important for importers to implement best practices to identify and report potential violations of import regulations before they escalate, says Samuel Finkelstein at LMD Trade Law.
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10 Practical Takeaways From FDA's Biopharma AI Guidance
Recent guidance from the U.S. Food and Drug Administration provides much-needed insight on the usage of artificial intelligence in producing information to support regulatory decision-making regarding drug safety, with implications ranging from life cycle maintenance to AI tool acquisition, say attorneys at Covington.
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Lawmakers Shouldn't Overlook Rare Disease Therapies' Value
As the ORPHAN Cures Act is pending in Congress, policymakers assessing the value of certain drugs for price regulation should consider data beyond what is collected in clinical trials, say Alice Chen at the University of Southern California, and Molly Frean and Yao Lu at Analysis Group.
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What Trump's Order Means For The Legal Status Of IVF
An executive order signed by President Donald Trump last month signals the administration's potential intention to increase protections for in vitro fertilization services, though more concrete actions would be needed to resolve the current uncertainty around IVF access or bring about a binding legal change, says Jeanne Vance at Weintraub Tobin.
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Mitigating Tariff Risks For Healthcare In US And Canada
Healthcare stakeholders should take steps to evaluate the impact of cross-border tariffs, as the historically strong ties between Canada and the U.S. demonstrate the potential for real disruption and harm to the healthcare industry in both countries, say attorneys at Norton Rose.
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What's At Stake In High Court Transgender Care Suit
The outcome of U.S. v. Skrmetti will have critical implications for the rights of transgender youth and their access to gender-affirming care, and will likely affect other areas of law and policy involving transgender individuals, including education, employment, healthcare and civil rights, say attorneys at ArentFox Schiff.
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6 Laws Transforming Calif.'s Health Regulatory Framework
Attorneys at Hooper Lundy discuss a number of new California laws that raise pressing issues for independent physicians and small practice groups, ranging from the use of artificial intelligence to wage standards for healthcare employees.
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Anticipating Calif. Oversight Of PE Participation In Healthcare
A new bill recently introduced in the California Senate revives last year's attempt to increase oversight of healthcare transactions involving private equity groups and hedge funds, meaning that attorneys may soon need to assess the compliance status of existing management relationships and consider modifying contract terms, says Andrew Demetriou at Husch Blackwell.