Policy & Compliance
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November 22, 2024
Duke Health Sacked Worker Over Pregnancy, Suit Claims
A Duke University-affiliated health network fired a radiology technologist just three days after she disclosed she was pregnant with her second child, according to a lawsuit in North Carolina federal court.
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November 22, 2024
3 Takeaways From 6th Circ. ERISA Disability Benefits Revival
A recent Sixth Circuit ruling that handed a worker a new shot at long-term disability benefits gives a boost to plaintiffs battling caps on coverage for mental health conditions, attorneys say. Here, Law360 looks at three takeaways from the appeals court's decision.
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November 22, 2024
Medicaid Fraud Nets 11-Year Sentence For NC Social Worker
A clinical social worker in North Carolina has been sentenced to more than 11 years behind bars on charges of defrauding South Carolina's Medicaid program and falsely obtaining COVID-19 relief checks, prosecutors said.
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November 21, 2024
Health Exec Who Fled Gets 3 Years For $8M Medicare Scheme
A home healthcare executive who led a scheme to defraud Medicare of nearly $8 million through fraudulent billing practices and who fled the country after his indictment has been sentenced to more than three years in prison, according to a judgment filed in Michigan federal court Wednesday.
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November 21, 2024
In Tight Vote, Senate Panel OKs Bill To Set New PTAB Limits
The Senate Judiciary Committee on Thursday narrowly voted to advance a bill that would impose new restrictions on Patent Trial and Appeal Board challenges, with several members expressing concern that it could drive up the cost of prescription drugs.
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November 21, 2024
NY Health Insurer Sued Over Booting Up, Logging Off Time
A New York health insurer failed to pay customer service representatives for the time needed to get their workstations ready, leading to unpaid overtime and missed lunch breaks, according to a proposed class and collective action filed in federal court Friday.
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November 21, 2024
NY Hospital GC Accuses State Of Mishandling Medicaid Funds
The general counsel of Nassau University Medical Center, who is also serving as interim president and CEO, is leading the Long Island hospital into a legal battle with the state of New York over $1 billion in federal Medicaid funds.
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November 20, 2024
Musk, Ramaswamy Say High Court Rulings OK Federal Cuts
Billionaire Elon Musk and former presidential candidate Vivek Ramaswamy, President-elect Donald Trump's picks to lead a newly created "Department of Government Efficiency," on Wednesday said two recent U.S. Supreme Court rulings will give them the authority to cut off power to regulatory agencies and conduct massive federal layoffs.
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November 20, 2024
Hospital's Med Mal Win Axed By Mich. Appeals Panel
A divided Michigan Court of Appeals panel has revived a medical malpractice lawsuit against a Michigan hospital, finding that the patient established a genuine fact dispute regarding her reasonable belief that the gynecologist treating her was acting as the hospital's agent.
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November 20, 2024
PBMs Sue To Block FTC's In-House Insulin Pricing Case
Caremark Rx, Express Scripts and OptumRx have lodged a constitutional challenge of the Federal Trade Commission's in-house case accusing the pharmacy benefits managers of artificially inflating insulin prices through unfair rebate schemes.
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November 20, 2024
3 States To Challenge Abortion Regs After Docs Drop Claims
Anti-abortion medical groups that were dealt a loss by the U.S. Supreme Court earlier this year have now dropped out of their lawsuit challenging federal approvals for mifepristone, leaving Missouri, Idaho and Kansas to carry on litigation over the abortion medication.
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November 19, 2024
W.Va. Amendment Marks Obstacle For Aid-In-Dying Movement
A first-of-its-kind prohibition in West Virginia on medically assisted suicide represents a new form of opposition to a growing movement that supports allowances for doctors to help patients with terminal illnesses end their lives.
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November 19, 2024
UnitedHealthcare Can't Escape Patient's Proton Beam Suit
A Florida federal judge on Tuesday refused to toss a federal benefits lawsuit from a patient who alleged that UnitedHealthcare wrongly denied him coverage for proton beam therapy to treat tongue cancer, rejecting the insurer's argument that an exclusion for unproven treatments applied.
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November 19, 2024
Insurers Urge Arbitration Of Union Fund's ERISA Claims
Elevance Health Inc. and several affiliated health insurers want a Connecticut federal judge to force arbitration of claims brought by a union fund that alleges excessive fees violated benefits law, arguing that the companies were unaware of an arbitration agreement with the plaintiff when they started litigating the early stages of a proposed class action.
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November 19, 2024
Widow Can't Get Malpractice Suit Over Husband's Fall Revived
A North Carolina appeals court on Tuesday declined to reinstate a suit by a widow alleging that nurses at Charlotte-Mecklenburg Hospital were responsible for a fall taken by her husband while he was recovering from brain surgery, saying the trial court rightly excluded her expert's testimony.
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November 19, 2024
10th Circ. Iffy On Colo.'s Remedy To Generic EpiPen Takings
A Tenth Circuit panel on Tuesday pressed Colorado regulators on whether requiring epinephrine auto-injector makers to repeatedly sue over the cost of complying with a state program provides an adequate legal remedy, with one judge saying that that route offers no finality for manufacturers.
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November 19, 2024
No 'Tin Hats': Fluoride Ruling Offers Options As RFK Eyes Ban
A California federal court decision that plunged deep into the scientific research on fluoride's impact on human health may offer Robert F. Kennedy Jr. and the incoming Trump administration a path to discouraging — or even banning — the fluoridation of drinking water.
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November 19, 2024
Trump Taps Dr. Oz For CMS Head
President-elect Donald Trump announced on Tuesday he will nominate TV personality Dr. Mehmet Oz to be administrator of the Centers for Medicare & Medicaid Services.
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November 19, 2024
Advocates Brace For Trump Shift On Emergency Abortion Law
After an unsatisfactory U.S. Supreme Court decision and the Biden administration battle over the Emergency Medical Treatment and Active Labor Act now back in the circuit courts, abortion access advocates are bracing for another twist: the return of Donald Trump to the White House.
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November 19, 2024
Nonpracticing Doc Can't Testify In Med Mal Case, Court Says
A Florida state appeals court has affirmed the dismissal of a case accusing a doctor of botching two shoulder surgeries, agreeing with a lower court's findings that a physician-turned-legal-consultant wasn't qualified to testify as the plaintiff's medical expert under the law.
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November 19, 2024
Akin Adds Another Healthcare Expert To DC Lobbying Team
The former chief health adviser for the Senate Finance Committee's majority has joined Akin Gump Strauss Hauer & Feld LLP's lobbying team in Washington, D.C., weeks after the firm added another healthcare advocate from the national association representing pharmacy benefit managers.
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November 18, 2024
3rd Circ. Shuts Down Healthcare Workers' Vax Bias Suit
A split Third Circuit panel said a group of Christian workers can't revive suits claiming a healthcare provider illegally fired them for refusing the COVID-19 vaccine on religious grounds, finding they failed to show how their beliefs prevented them from getting immunized.
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November 15, 2024
Eli Lilly Says HHS Ignores Drug Discount Double-Dipping
Eli Lilly & Co. claims the U.S. Department of Health and Human Services is unlawfully blocking its efforts to crack down on hospitals the company alleges are double-dipping on medication discounts that are meant to benefit low-income patients, according to a lawsuit filed in D.C. federal court.
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November 15, 2024
HHS Likely To Limit Migrant Data After Flores Deal Ends
A California federal judge indicated Friday that she can't force the U.S. Department of Health and Human Services to provide human rights groups with regular data about children in low-security detention facilities now that the long-running Flores settlement has been replaced with a government regulation.
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November 15, 2024
PBMs Denied Breakup Of Combined FTC Insulin Price Trial
The Federal Trade Commission's allegations that pharmacy benefit manager giants Caremark Rx, Express Scripts and OptumRx are artificially inflating insulin prices through unfair rebate schemes will forge ahead as a single case following an in-house agency judge's refusal to break them into separate proceedings.
Expert Analysis
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What Drug Cos. Must Know About NY Price Transparency Law
Drug manufacturers must understand the contours of New York's recently implemented law requiring self-reporting of drug price increases, as well as best practices for compliance and challenges against similar laws in other states, say Elizabeth Bierut and Angie Garcia at Friedman Kaplan.
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Whistleblowers Must Note 5 Key Differences Of DOJ Program
The U.S. Department of Justice’s recently unveiled whistleblower awards program diverges in key ways from similar programs at other agencies, and individuals must weigh these differences and look first to programs with stronger, proven protections before blowing the whistle, say Stephen Kohn and Geoff Schweller at Kohn Kohn.
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The Licensure Landscape For Psychedelics Manufacturers
As the need for bulk manufacturing of psychedelic substances grows, organizations aiming to support clinical trials or become commercial suppliers must navigate a rigorous and multifaceted journey to obtaining a license from the U.S. Drug Enforcement Administration, say Kimberly Chew at Husch Blackwell and Jaime Dwight at Promega Corp.
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OSHA Workplace Violence Citation Highlights Mitigation Steps
The Occupational Safety and Health Administration's recent citation against behavioral health company Circles of Care sheds light on the enforcement risks companies may face for failing to prevent workplace violence, and is a reminder of the concrete steps that can help improve workplace safety, say attorneys at Benesch.
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When Banks Unknowingly Become HIPAA Biz Associates
There appears to be significant confusion regarding the application of the Health Insurance Portability and Accountability Act to financial institutions when serving healthcare-related clients, so these institutions should consider undertaking several steps as a starting point in the effort to achieve compliance, say attorneys at Vorys.
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The Regulatory Headwinds Facing Lab-Developed Tests
Though the U.S. Food and Drug Administration's final rule regarding regulation of laboratory-developed tests outlines a four-year plan for ending enforcement discretion, and though this rule is currently being challenged in courts, manufacturers should heed compliance opportunities immediately as enforcement actions are already on the horizon, say attorneys at Kirkland & Ellis.
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3 High Court Rulings May Shape Health Org. Litigation Tactics
Three separate decisions from the U.S. Supreme Court's most recent term — Loper Bright, Corner Post and Jarkesy — will likely strengthen healthcare organizations' ability to affirmatively sue executive agencies to challenge regulations governing operations and enforcement actions, say attorneys at McDermott.
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A New Way Forward For COVID Vaccine Lawsuit Immunity
As Public Readiness and Emergency Preparedness Act protections for COVID-19 vaccines wane, adding those vaccines to coverage by the National Vaccine Injury Compensation Program would bolster defenses for administrators and manufacturers while also providing stronger remedies for those injured by vaccines, says Altom Maglio at MCT Law.
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Why DOJ's Whistleblower Program May Have Limited Impact
The U.S. Department of Justice’s new whistleblower pilot program aims to incentivize individuals to report corporate misconduct, but the program's effectiveness may be undercut by its differences from other federal agencies’ whistleblower programs and its interplay with other DOJ policies, say attorneys at Milbank.
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How Cos. With Chinese Suppliers Should Prep For Biotech Bill
A proposed bill to prohibit government-affiliated life sciences companies from contracting with Chinese biotech companies of concern may necessitate switching to other sources for research and supplies, meaning they should begin evaluating supply chains now due to the long lead times of drug development, say John O'Loughlin and Christina Carone at Weil Gotshal.
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FTC's Drug Middlemen Probe Highlights Ongoing Scrutiny
The Federal Trade Commission's interim staff report on its inquiry into pharmacy benefit managers suggests that the industry will remain under an enforcement microscope for the foreseeable future due to concerns about how PBMs affect drug costs and accessibility, say attorneys at Arnold & Porter.
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What Cos. Should Note In DOJ's New Whistleblower Pilot
After the U.S. Department of Justice unveiled a new whistleblower pilot program last week — continuing its efforts to incentivize individual reporting of misconduct — companies should review the eligibility criteria, update their compliance programs and consider the risks and benefits of making their own self-disclosures, say attorneys at Skadden.
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Motion To Transfer Venue Considerations For FCA Cases
Several recent decisions highlight the importance for practitioners of analyzing as early as possible whether a False Claims Act case warrants a change of venue, and understanding how courts weigh certain factors for defendants versus whistleblowers, say Ellen London at London & Stout, and Li Yu and Corey Lipton at DiCello Levitt.