Policy & Compliance
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July 29, 2025
Ark. Law Banning PBM-Owned Pharmacies Put On Ice
Arkansas can't enforce a law banning pharmacy benefit managers from owning pharmacies in the state, a federal judge ruled, saying that CVS, Express Scripts, Optum and a trade group are likely to succeed on their claims that the statute unlawfully restricts interstate commerce.
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July 29, 2025
9th Circ. Clarifies Kickback Boundaries For Referral Bonuses
A Ninth Circuit opinion affirming a California man's fraud conviction provides some clarity — and a warning — to the owners of medical testing laboratories wondering what sales tactics are allowed under a 2018 kickbacks law.
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July 29, 2025
Meet Josh Craddock, Fetal Personhood Advocate Joining DOJ
President Donald Trump has named a former BigLaw attorney and outspoken proponent of the fetal personhood legal doctrine to serve as deputy assistant attorney general at the legal arm of the U.S. Department of Justice.
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July 28, 2025
PBMs Can't Escape NY State Law Claims In Opioid MDL
Two UnitedHealth subsidiaries cannot escape claims that they exacerbated the opioid crisis by providing data analytics and consulting services to drugmakers, a federal judge overseeing the multidistrict litigation ruled on Monday, saying the New York state municipalities have adequately alleged RICO by claiming they were part of the same criminal conspiracy.
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July 28, 2025
Express Scripts, Prime Urge Court To Toss Mich. Price-Fix Suit
Two pharmacy benefit managers sought to shake allegations of price-fixing brought by Michigan Attorney General Dana Nessel, arguing Friday that her antitrust suit suffers from several fatal legal flaws, including that the state does not have standing to sue on pharmacies' behalf.
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July 28, 2025
DOJ Probes NewYork-Presbyterian Over Antitrust Allegations
The U.S. Department of Justice has opened an investigation into NewYork-Presbyterian Healthcare System for allegedly violating antitrust laws by cutting deals with insurance companies that have led to rising healthcare costs, according to a subpoena viewed by Law360.
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July 28, 2025
Judge Again Cites Bias In NIH Fund Freeze As Gov't Appeals
A Massachusetts federal judge on Monday reiterated his conclusion that the Trump administration's freeze of $783 million worth of National Institutes of Health grants was based on "palpable" gender and racial discrimination, as he acknowledged a pending request by the government to the U.S. Supreme Court to stay his order that the money be released.
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July 28, 2025
Judge Says Trump Admin Can't Defund Planned Parenthood
A Massachusetts federal judge on Monday blocked President Donald Trump's administration from denying Medicaid reimbursements to Planned Parenthood clinics, expanding an earlier ruling that had applied only to those that do not provide abortions or that receive minimal federal support.
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July 25, 2025
Utah Docs Say Billing Expert's Report Rife With AI Falsehoods
Utah anesthesiologists facing a False Claims Act suit are moving to bar the testimony of a medical billing expert they say used artificial intelligence to draft a report riddled with errors and fake citations, calling it an extraordinary example of AI gone wrong.
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July 25, 2025
Hospital Giant To Pay $3.5M Over Nurse Training Repayments
HCA Healthcare Inc., a major U.S. hospital operator, has agreed to pay roughly $3.5 million to settle claims that it unlawfully trapped new nurses in agreements requiring them to repay training costs if they left their jobs within two years, according to a trio of state attorneys general.
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July 25, 2025
Health Data Co. Investor Fraud Suit Headed To Mediation
The parties in a putative class action claiming a healthcare technology company misled investors about a data platform it claimed to operate, but which didn't actually exist, told a Connecticut federal court that they "agree this case is well suited for mediation."
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July 24, 2025
Trump Admin Asks Justices To Stay Block On NIH Grant Cuts
The Trump administration on Thursday urged the U.S. Supreme Court to stay a district court's preliminary injunction so that the National Institutes of Health can resume terminating $783 million in grants, saying the lower court, under a recent high court ruling, lacked jurisdiction to make the government pay the grants.
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July 24, 2025
Hospital Must Face Claims Of Mismanaging Retirement Funds
A Colorado federal judge on Thursday said a proposed class action will continue against a hospital over allegations of mismanaging employees' retirement funds after an amended complaint added new allegations about the fund's mismanagement.
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July 24, 2025
UnitedHealth Discloses DOJ Medicare Civil, Criminal Probes
UnitedHealth Group Inc. has disclosed that it is complying with formal criminal and civil requests from the U.S. Department of Justice, following media reports about investigations into aspects of the insurance giant's participation in Medicare.
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July 24, 2025
3rd Circ. Rules Philly Injection Site Equals Religious 'Person'
A nonprofit battling government resistance to its planned safe drug injection site in Philadelphia can qualify for religious freedom protections, the Third Circuit said in a precedential opinion on Thursday, reasoning the organization meets the definition of a "person" practicing religion.
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July 23, 2025
FTC Wants PE Firm's Medical Device Coating Deal Put On Ice
Private equity firm GTCR BC Holdings' $627 million merger with Surmodics will bring the previously fierce competition for medical device coatings to a grinding halt, the FTC says, which is all the more reason a federal court should block the deal while an agency challenge plays out.
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July 23, 2025
Symbria Workers' $5.9M ESOP Deal Gets Ill. Judge's Final OK
An Illinois federal judge gave his final blessing Tuesday to a $5.9 million settlement between Argent Trust Co. and a group of Symbria Inc. employees who accused the company of mismanaging their employee stock ownership plan.
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July 23, 2025
Bird Marella And Bioscience Client Accused Of $87M Fraud
An investment group that includes a "Toy Story" screenwriter is suing a Culver City, California-headquartered bioscience company and its Bird Marella attorneys in California state court, accusing them of manipulating the valuation of a company whose acquisition they funded, in order to defraud investors of $87 million.
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July 23, 2025
Co., Lenders Hit With Suit Over Medical Spa Financing Scam
A medical device manufacturer and several financing companies worked together to manipulate boutique clinics and medical spas into purchasing expensive cosmetic devices based on inflated revenue projections and false promises of marketing support, according to a proposed class action filed Monday in California federal court.
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July 22, 2025
FCA Draws Heavy Constitutional Fire After $1.6B J&J Verdict
Reeling from a record fraud verdict tied to drug promotion practices, Johnson & Johnson is pursuing a sweeping constitutional challenge to the False Claims Act, and in filings this week at the Third Circuit, major industry allies rallied behind its views of whistleblower litigants usurping executive branch power.
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July 22, 2025
Healthcare In Court: NIH Grant Cuts, Flo Health Trial And More
A First Circuit panel refused to hit pause on a Massachusetts federal judge's order voiding cuts by the National Institutes of Health to hundreds of grant programs. Meanwhile, in California, a jury trial kicked off over allegations of unlawful information sharing between menstrual app developer Flo Health Inc. and Meta Platforms.
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July 22, 2025
Sandoz Loses 'Nonsense' Bid To Avoid DOJ Deal In AGs' Case
A Connecticut federal judge has given dozens of state attorneys general a small but important win in a sprawling price-fixing litigation against generic-drug makers, applying previous admissions of criminal wrongdoing and flatly rejecting "ridiculous" efforts by Sandoz, Taro Pharmaceuticals and a former Sandoz official to avoid that application.
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July 22, 2025
Ohio Justices Accept AG's Bid To Limit Care For Trans Youths
The Ohio Supreme Court on Tuesday agreed to review an appeals court's finding that portions of a state law restricting gender-affirming care for transgender youths are unconstitutional.
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July 22, 2025
Employers, Plans Force Freeze Of Iowa's PBM Law
A federal judge slapped a temporary hold on parts of an Iowa law that aims to limit pharmacy benefit managers' power to set drug prices, ruling that provisions barring discrimination against certain pharmacies and pushing cost-saving strategies are preempted by federal benefits law.
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July 22, 2025
4th Circ. Backs Medicaid Fraud Conviction, 17-Year Sentence
A North Carolina lab owner lost his bid Tuesday to overturn his healthcare fraud conviction after the Fourth Circuit found evidence against him to be sufficient and the terms of his sentence reasonable.
Expert Analysis
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Recent Reports Shed Light On Section 340B's Effectiveness
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.
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What Parity Rule Freeze Means For Plan Sponsors
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.
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CMS Guidance May Complicate Drug Pricing, Trigger Lawsuits
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.
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3 Takeaways From Recent Cyberattacks On Healthcare Cos.
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.
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Most-Favored Nation Drug Pricing Could Shake Up US Pharma
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.
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How Focus On Menopause Care Is Fueling Innovation, Access
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.
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FDA Commissioner Speech Suggests New Vision For Agency
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.
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Customs Fraud Enforcement In The Age Of Tariffs
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.
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Legal Risks For Providers Discussing Psychedelic Therapies
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.
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How NY's FAIR Act Mirrors CFPB State Recommendations
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.
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A Breakdown Of Trump's Order On Drug Pricing
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.
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Takeaways From DOJ's 1st Wage-Fixing Jury Conviction
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.
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Deregulation Memo Presents Risks, Opportunities For Cos.
A recent Trump administration memo providing direction to agencies tasked with rescinding regulations under an earlier executive order — without undergoing the typical notice-and-review process — will likely create much uncertainty for businesses, though they may be able to engage with agencies to shape the regulatory agenda, say attorneys at Blank Rome.