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Policy & Compliance

  • June 25, 2025

    BREAKING: CVS PBM Hit With $95M Judgment For Overbilling Medicare

    A Pennsylvania federal judge on Wednesday ruled that CVS's pharmacy benefits manager owes the government $95 million for overbilling Medicare Part D-sponsored drugs, leaving the door open for the amount to be tripled later.

  • June 24, 2025

    Arkansas Insurance Dept. Fights Teamsters Plan's ERISA Suit

    The Arkansas Insurance Department is looking to sink a challenge to a state insurance regulation filed by a Teamsters healthcare plan, telling an Illinois federal judge that the regulation isn't preempted by the Employee Retirement Income Security Act and, besides, the plan can't sue the department.

  • June 24, 2025

    Health Data Co. Must Face Revised Investor Fraud Suit

    A Connecticut federal judge won't toss an amended class action claiming a healthcare technology company misled investors about a data platform it claimed to operate that didn't actually exist, ruling that statements about the platform's capabilities are not inactionable, forward-looking statements.

  • June 24, 2025

    4th Circ. Tosses Trans Man's Appeal Over Canceled Surgery

    The Fourth Circuit declined to revive a transgender man's constitutional claims against a religious hospital run by the University of Maryland Medical System over a canceled hysterectomy for gender dysphoria, concluding Tuesday that it couldn't grant further relief, and refused to consider a "late-breaking" argument for emotional distress damages.

  • June 24, 2025

    Calif. AG Asks 9th Circ. To Undo Limits On Pay-For-Delay Ban

    California enforcers on Monday asked the Ninth Circuit to overturn a district court's decision that a state law restricting "reverse payment" settlements between brand-name and generic-drug makers cannot be used to regulate deals that were struck outside the Golden State.

  • June 24, 2025

    Healthcare In Court: 5 Rulings You May Have Missed

    A D.C. federal judge rejected a challenge to the federal government's approval of an audit by Johnson & Johnson into five hospitals' compliance with the 340B drug discount program. In Texas, a state appellate court has blocked San Antonio from going forward with a program that could fund travel for residents to access abortion care in other states. Here, Law360 Healthcare Authority looks at those and other healthcare rulings you may have missed over the last week.

  • June 24, 2025

    Nichols Liu Co-Founder Andy Liu Launches Solo Venture

    Boutique firm Nichols Liu LLP's co-founding partner Andy Liu has launched a solo practice to continue representing government contractors and healthcare industry clients in civil and criminal enforcement matters, telling Law360 Pulse Tuesday he wanted to go out on his own for greater control.

  • June 24, 2025

    Trump Admin Must Release NIH Funds Amid Appeal

    A Massachusetts federal judge on Tuesday denied the Trump administration's request to stay a recent order that it resume processing National Institutes of Health grant applications and releasing funds, warning that even one more day of delay would lead to irreparable harm.

  • June 23, 2025

    Ontrak Founder Gets 3½ Years In Novel Insider Trading Case

    A California federal judge sentenced Ontrak Inc. founder Terren Peizer to 3½ years in prison Monday, following a first-of-its-kind insider trading conviction on accusations that he based a $20 million share sale on material nonpublic information that his health technology company was about to lose its biggest client, Cigna. 

  • June 23, 2025

    9th Circ. Sends Minor's Rehab Claim Back To Premera

    The Ninth Circuit on Monday partially reopened a lawsuit accusing Premera Blue Cross of unlawfully refusing to cover a minor's time in a wilderness therapy program and rehabilitation facility, saying the insurer should take another look at one of the claims.

  • June 23, 2025

    Justices Skip Pa. Med Mal Fund's Bid To Shield $300M Surplus

    The U.S. Supreme Court said Monday it won't decide if Pennsylvania's medical malpractice insurance fund is a government entity for the purpose of determining if the state is authorized to dip into the money pool's $300 million budget surplus. 

  • June 20, 2025

    Texas Panel Blocks San Antonio's Abortion Travel Funding

    A Texas appellate court blocked the city of San Antonio from going forward with a program that included funding for out-of-state travel for abortions, finding that the state has the right to challenge the program even though the funding has not yet been spent.

  • June 20, 2025

    PE Firm Demands FDA Docs For Defense In Deal Challenge

    Private equity firm GTCR BC Holdings LLC is seeking a court order for the U.S. Food and Drug Administration to produce over a decade's worth of medical device approval applications, arguing the documents are necessary in its defense against a merger challenge by the federal government.

  • June 20, 2025

    Nose Spray Co. Sues FTC Over Substantiation Requirement

    Nasal spray maker Xlear Inc. is suing the Federal Trade Commission in Utah federal court, seeking a declaration that the agency is going beyond its statutory mandate by requiring scientific substantiation in marketing claims, even if the claims are not false and misleading.

  • June 20, 2025

    4 ERISA Cases To Watch In The 2nd Half Of 2025

    The U.S. Department of Labor's challenge to a pair of injunctions blocking Biden-era regulations that broaden who qualifies as an investment advice fiduciary under federal benefits law tops the list of cases benefits attorneys will be watching in the latter half of the year.

  • June 18, 2025

    Texas Judge Vacates Biden-Era HHS Abortion Privacy Rule

    A Texas federal judge on Thursday agreed to vacate a U.S. Department of Health and Human Services rule finalized during the Biden administration that aimed to protect the privacy of patients seeking abortions and gender-affirming care, ruling that the HHS didn't have the authority to "fashion special protections" in areas of "great political significance."

  • June 18, 2025

    NC Panel Rejects HCA Unit's Appeal Over Rival Project Award

    A North Carolina appeals court on Wednesday rejected an HCA Healthcare subsidiary's challenge to an award of a certificate of need allowing a rival to build a new acute care facility, backing a decision in favor of the state health department behind the award.

  • June 18, 2025

    Nurse Staffing Exec Can't Nix Conviction, Sanctions Floated

    A Nevada federal court has refused a nurse staffing executive's bid to undo his conviction on wage-fixing and wire fraud charges, and threatened his attorneys with sanctions for allegedly making repeated misrepresentations to the court.

  • June 18, 2025

    High Court Concurrences Signal Hard Battle For Trans Rights

    U.S. Supreme Court Justice Amy Coney Barrett joined the court's two most conservative members Wednesday to suggest laws that differentiate based on transgender status should be subject to the lowest level of judicial review, providing guidance to lower courts that will likely make it harder for litigants to vindicate trans rights.

  • June 18, 2025

    NY High Court Lifts Block On NYC Shifting Retiree Healthcare

    New York's highest court lifted an injunction Wednesday that had blocked New York City from switching retired city employees' health insurance provider, ruling that the city never promised its retirees that it would keep them on a Medicare supplemental plan.

  • June 18, 2025

    Ex-Drug Exec Must Testify, But Keeps 5th Amendment Rights

    Sandoz, Teva, Actavis and Taro can again subpoena the deposition testimony of a former Actavis and Teva executive, but a Pennsylvania federal judge is still allowing the witness to invoke his Fifth Amendment rights against self-incrimination, even though the Justice Department dropped the criminal charges against him.

  • June 18, 2025

    Age Bias Taints Kansas Health Dept. Promotions, EEOC Says

    The Kansas Department of Health and Environment overlooked an older worker for promotions to more senior lab tech roles solely because of her age, the U.S. Equal Employment Opportunity Commission told a federal court.

  • June 18, 2025

    DC Judge Throws Out Suits Over J&J Drug Discount Audits

    A D.C. federal judge nixed five lawsuits brought by hospitals that accused federal healthcare regulators of illegally authorizing Johnson & Johnson to audit their business records for compliance with the 340B drug discount program.

  • June 18, 2025

    5th Circ. Affirms Nix Of Ex-Hospital Workers' COVID Vax Suit

    The Fifth Circuit backed a Houston hospital's defeat of a lawsuit alleging that hundreds of employees were unlawfully fired when they refused to get the COVID-19 vaccine, saying the workers couldn't demonstrate that their right to reject the shot had been violated.

  • June 18, 2025

    Supreme Court Upholds Tennessee Transgender Care Ban

    The U.S. Supreme Court on Wednesday upheld a Tennessee ban on gender-affirming medical care for minors, finding that the state law does not violate the equal protection clause.

Expert Analysis

  • Legacy Of 3 Justices Should Guide Transgender Rights Ruling

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    Three Republican-appointed U.S. Supreme Court justices — Anthony Kennedy, Sandra Day O'Connor and David Souter — gave rise to a jurisprudence of personal liberty that courts today invoke to protect gender-affirming care, and with the court now poised to decide U.S. v. Skrmetti, it must follow the path that they set, says Greg Fosheim at McDermott.

  • Recent Reports Shed Light On Section 340B's Effectiveness

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    Recent analyses of the Section 340B program's effectiveness in helping patients afford drugs in Minnesota reinforce concerns about the program's lack of transparency and underscore the need for further evaluation of whether legislative reform should be enacted, say William A. Sarraille at the University of Maryland, and Andrée-Anne Fournier and Molly Frean at Analysis Group.

  • What Parity Rule Freeze Means For Plan Sponsors

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    In light of a District of Columbia federal court’s recent decision to stay litigation challenging a Mental Health Parity and Addiction Equity Act final rule, as well as federal agencies' subsequent decision to hold off on enforcement, attorneys at Morgan Lewis discuss the statute’s evolution and what plan sponsors and participants can expect going forward.

  • CMS Guidance May Complicate Drug Pricing, Trigger Lawsuits

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    Recent draft guidance from the Centers for Medicare & Medicaid Services proposes to expand the scope of what counts as the same qualifying single-source drug, which would significantly alter the timeline for modified drugs facing price controls and would likely draw legal challenges from innovator drug companies, say attorneys at Debevoise.

  • 3 Takeaways From Recent Cyberattacks On Healthcare Cos.

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    For the healthcare industry, the upward trend in styles of cyberattacks, costs, and entities targeted highlights the critical importance of proactive planning to help withstand the operational, legal and reputational turmoil that can follow a data breach, say attorneys at Troutman Pepper.

  • Most-Favored Nation Drug Pricing Could Shake Up US Pharma

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    Recent moves from the executive and legislative branches represent a serious attempt to revive and refine the first Trump administration's most-favored-nations model for drug pricing, though implementation could bring unintended consequences for pharmaceutical manufacturers and will likely draw significant legal opposition, say attorneys at Morgan Lewis.

  • How Focus On Menopause Care Is Fueling Innovation, Access

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    Recent legislative developments concerning the growing field of menopause care are creating opportunities for increased investment and innovation in the space as they increase access to education and coverage, say attorneys at Kirkland.

  • FDA Commissioner Speech Suggests New Vision For Agency

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    In his first public remarks as U.S. Food and Drug Administration commissioner, Marty Makary outlined an ambitious framework for change centered around cultural restoration, scientific integrity, regulatory flexibility and selective modernization, and substantial enforcement shifts for the food and tobacco sectors, say attorneys at Arnall Golden.

  • Customs Fraud Enforcement In The Age Of Tariffs

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    In the wake of the Trump administration’s new approach toward tariffs, two recent Justice Department developments demonstrate aggressive customs fraud enforcement, with the DOJ emphasizing competitive harm to American businesses, and signaling that investigations will likely involve both civil and criminal enforcement tools, say attorneys at Bernstein Litowitz and London & Naor.

  • Legal Risks For Providers Discussing Psychedelic Therapies

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    The emergence of psychedelic therapies as potential treatments for mental health conditions and other ailments continues to garner significant attention, but the legal landscape surrounding discussions and referrals remains fraught with complexity, creating potential risks for healthcare providers and institutions, says Kimberly Chew at Husch Blackwell.

  • How NY's FAIR Act Mirrors sa¹ú¼Ê´«Ã½ State Recommendations

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    New York's proposed FAIR Business Practices Act, which targets predatory lending and junk fees, reflects the Rohit Chopra-era Consumer Financial Protection Bureau's recommendations to states in a number of ways, including by defining "abusive" conduct and adding a new right to file class actions, says Christian Hancock at Bradley Arant.

  • A Breakdown Of Trump's Order On Drug Pricing

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    The Trump administration may attempt to effectuate through rulemaking a recently issued executive order on lowering drug prices, which would likely have an adverse effect on stakeholders and trigger litigation, say attorneys at Debevoise.

  • Takeaways From DOJ's 1st Wage-Fixing Jury Conviction

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    U.S. v. Lopez marked the U.S. Department of Justice's first labor market conviction at trial as a Nevada federal jury found a home healthcare staffing executive guilty of wage-fixing and wire fraud, signaling that improper agreements risk facing successful criminal prosecution, say attorneys at McGuireWoods.