Policy & Compliance

  • June 25, 2025

    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

    Docs Navigate 'Legal Thicket' Of Pregnancy Exclusion Laws

    A first-of-its-kind lawsuit in Kansas challenges a state law that plaintiffs say undermines a woman's right to make critical end-of-life decisions while pregnant and leaves doctors legally vulnerable.

  • 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.

Expert Analysis

  • A Look At Drug Price Negotiation Program's Ongoing Impact

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    More than two years after the passage of the Inflation Reduction Act and the rapid implementation of the drug price negotiation program, attorneys at Ropes & Gray discuss how the IRA has influenced licensing strategies, and how maximum fair prices under the law have economically affected certain drugs.

  • Preparing For A Possible End To The Subminimum Wage

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    The U.S. Department of Labor's proposed rule to end the subminimum wage for employees with disabilities may significantly affect the community-based rehabilitation and training programs that employ these workers, so certified programs should be especially vigilant about compliance during this period of evaluation and scrutiny, say attorneys at Jackson Lewis.

  • Drug Pricing Policy Trends To Expect In 2025 And Beyond

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    Though 2025 may bring more of the same in the realm of drug pricing policy, business as usual entails a sustained, high level of legal and policy developments across at least six major areas, say attorneys at Ropes & Gray.

  • Top 10 Healthcare And Life Sciences Issues To Watch In 2025

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    Under the new Trump administration, this coming year may benefit some healthcare and life sciences stakeholders, while creating new challenges for others amid an increasingly complex regulatory environment, say attorneys at Debevoise.

  • 4 Keys To Litigating In An Active Regulatory Environment

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    For companies facing litigation influenced by government regulatory action — a recent trend that a politically charged atmosphere will exacerbate — there are a few principles that can help to align litigation strategy with broader public positioning in the regulatory and oversight context, say attorneys at Jenner & Block.

  • How Views On Healthcare Price Transparency Are Changing

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    Regulators' attitudes toward price transparency regulation have shifted over the past several years in ways that may seem contradictory, and research into detailed rate information published by hospitals and health plans has yielded mixed results, says Matthew List at Charles River Associates.

  • EEOC Wearable Tech Guidance Highlights Monitoring Scrutiny

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    The U.S. Equal Employment Opportunity Commission's recent fact sheet on wearable technologies cautions against potential issues with federal anti-discrimination laws and demonstrates growing concern from regulators and legislators about intrusive technologies in the workplace, say attorneys at Littler.

  • Navigating The Potential End Of GLP-1 Drug Shortages

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    The U.S. Food and Drug Administration's determination of whether GLP-1 products are in shortage may affect how compounders provide these products and spur a range of litigation including patent disputes and unfair competition suits, say attorneys at Goodwin.

  • Politicized OIGs Could Target Federal Employees, Contractors

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    After President Donald Trump fired nearly 20 inspectors general last week, it’s worth exploring how the administration could use Offices of Inspectors General to target federal employees and contractors, why it would be difficult to fight this effort, and one possible bulwark against the politicization of these watchdogs, says Sara Kropf at Kropf Moseley.

  • Takeaways From DOJ Fraud Section's 2024 Year In Review

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    Attorneys at Paul Weiss highlight notable developments in the U.S. Department of Justice Fraud Section’s recently released annual report, and discuss what the second Trump administration could mean for enforcement in the year to come.

  • IVF Suits Highlight Need For Better Legal Frameworks

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    The high number of in vitro fertilization embryo losses underscores the need for more cohesive legal and regulatory guidance related to human errors, property versus personhood, and liability, says Jeff Korek at Gersowitz Libo.

  • Takeaways From FDA's Updated Confirmatory Trial Guidance

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    The U.S. Food and Drug Administration's latest draft guidance about accelerated drug approval indicates the FDA's intent to address the significant lag time between accelerated approval and full approval of drugs and may help motivate the industry to complete confirmatory trials, say attorneys at Sheppard Mullin.

  • A Look At FDA's Plans To Establish New OTC Drug Category

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    The U.S. Food and Drug Administration's recently finalized rule, creating a new over-the-counter pathway for drugs when patients satisfy certain conditions, may be useful for off-patent drugs with established safety records, though switching to OTC comes with additional costs and considerations, say attorneys at Skadden.