Medicaid and Medicare – Legal News Feed

Law360

Sidley Austin and Orrick Herrington Prevail in Novo Nordisk False Claims Act Case: A Legal Milestone in Pharmaceutical Defense

Pieter Gunst3 months ago03 mins

In this week’s edition of Law360’s Legal Lions, the spotlight shines on Sidley Austin LLP and Orrick Herrington & Sutcliffe LLP. These legal powerhouses successfully represented Novo Nordisk in a high-stakes case before a Washington federal jury. The case involved allegations that the pharmaceutical giant defrauded state Medicaid and Medicare systems through kickbacks and promotion…

Bloomberg Law

Balancing Act: The Crucial Role of Pharmacy Benefit Managers in U.S. Drug Pricing Debate

Pieter Gunst1 year ago04 mins

In the complex realm of U.S. drug pricing, pharmacy benefit managers (PBMs) have emerged as pivotal players, especially as they face scrutiny from both regulatory bodies and political entities. Amid ongoing allegations from the Federal Trade Commission and Congress regarding anti-competitive practices and their purported role in maintaining elevated drug prices, the role of PBMs…

Above the Law

Dismantling Mental Health Misconceptions: AI Integration and Holistic Care

Pieter Gunst2 years ago04 mins

While the discourse around mental health has notably broadened over the last decade, there persist several misconceptions in the space, asserts Dr. Mimi Winsberg, Chief Medical Officer of Brightside Health. Notably, corporations and insurance companies have been increasingly offering mental health support to their employees and members, lending momentum to the development of understanding and…

JDSupra

Navigating the Future of Managed Care: OIG’s Strategic Plan and Its Impact on Healthcare Organizations

Pieter Gunst2 years ago03 mins

The Department of Health & Human Services’ Office of Inspector General (OIG) has highlighted the remarkable growth of managed care in recent years, leading to significant changes in how Medicaid and Medicare fund healthcare for nearly 100 million enrollees. One telling statistic from 2022 reveals that half of Medicare enrollees obtained coverage via Medicare Advantage…

JDSupra

LA Health Care Plan Settles for $1.3 Million Over Potential HIPAA Violations

Pieter Gunst2 years ago03 mins

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) recently announced a sizeable settlement with L.A. Health Care Plan, according to a report on JD Supra. Meet L.A. Care – the nation’s largest publicly operated health plan, boasting a whopping roster of over 2.7 million members. The healthcare provider offers a…

Above the Law

Bon Secours Mercy Health Sues Anthem for $93 Million in Unpaid Claims

Pieter Gunst2 years ago04 mins

Bon Secours Mercy Health Virginia (BSMH Virginia), a health system conducting operations across 10 hospitals, has launched a lawsuit against health insurer Anthem Health Plans of Virginia (Anthem), a subsidiary of Elevance Health. The lawsuit references unpaid and underpaid health claims assertedly owed by the insurer, amounting to a reported $93 million. The complaint was…

JDSupra

OIG Approves Per-Click Marketing for Healthcare Directories, Impacting Legal Landscape

Pieter Gunst2 years ago03 mins

In a recent development, the US Department of Health and Human Services Office of Inspector General (OIG) has shared Advisory Opinion No. 23-04 on per-click marketing arrangements involving online healthcare directories. This move is highly significant for legal professionals, both in the corporate world and in law firms, given its implications for online healthcare marketing…

Other

Attorneys General Unite to Strengthen 340B Drug Discount Program

Pieter Gunst2 years ago02 mins

In recent developments around the 340B Drug Discount Program, a key prescription drug initiative in the United States, 23 attorneys general (AGs) from across party lines have raised pertinent concerns and recommendations. The cohort, comprising 21 Democrats and 2 Republicans, issued a letter in response to a request for information relayed by a bipartisan group…