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Medicare Part D Preemption: Supreme Court Review Uncertain  

By Michele Munk on Posted in 10th Circuit, 1st Circuit, 8th Circuit, Medicare Part D, U.S. Supreme Court
On July 29, 2024, Pharmaceutical Care Management Association (“PCMA”) filed an opposition to Oklahoma’s petition for writ of certiorari in the United States Supreme Court, seeking review of the Tenth Circuit decision PCMA v. Mulready, 78 F.4th 1183 (10th Cir. 2023). Oklahoma seeks review of both ERISA and Medicare Part D preemption.[1] Mulready held that … Continue Reading

In Purdue Pharma, the Supreme Court Fires a Canon of Construction Through Non-Consensual Third-Party Releases (US)

By Squire Patton Boggs on Posted in Bankruptcy, U.S. Supreme Court
On June 27, 2024, the Supreme Court ruled in a 5-4 decision that a bankruptcy court does not have the statutory authority to discharge creditors’ claims against a non-debtor without the creditors’ consent (except in asbestos cases).  The decision in Harrington v. Purdue Pharma settles a long-standing dispute in the bankruptcy world that will have significant impact on Purdue … Continue Reading

A New Era in Healthcare Regulation & Compliance

By Kayla Mendez on Posted in Regulations, U.S. Supreme Court
Loper Bright Shifts Statutory Interpretation Powers Back to the Courts. On June 28, 2024, the Supreme Court overturned the Chevron doctrine with its decision in Loper Bright Enterprises v. Raimondo.  Under Chevron, courts have historically deferred to a federal agency’s interpretation of ambiguity in statutes that the agency administers.  Courts premised Chevron deference on the notion that … Continue Reading

The End of “Chevron” or Its Rebirth?

By Squire Patton Boggs on Posted in Regulations, U.S. Supreme Court
Fishermen in the small town of Cape May, New Jersey, are at the epicenter of a legal challenge that could reshape the landscape of agency authority. The fishermen are challenging the entrenched “Chevron” doctrine, which for years has afforded deference to government agencies with respect to reasonable interpretation of ambiguous statutes. Once again, the US … Continue Reading

Supreme Court Holds Some Provisions of Federal Nursing Home Reform Act are Privately Enforceable under 42 U.S.C. §1983

By Robert Nauman on Posted in U.S. Supreme Court
Last month, the U.S. Supreme Court issued its decision in Health and Hospital Corporation of Marion County v. Talevski, holding that certain provisions of the Federal Nursing Home Reform Act (FNHRA) confer rights that are enforceable by individuals under 42 U.S.C. §1983. The case arises over HHC’s alleged treatment of a resident, Gorgi Talevski. Mr. … Continue Reading

Supreme Court Clarifies Knowledge Requirement for False Claims Act Liability

By Squire Patton Boggs on Posted in Compliance, False Claims Act, U.S. Supreme Court
In April, we previewed two significant False Claims Act (FCA) cases before the U.S. Supreme Court, United States ex. rel. Schutte v. SuperValu, Inc., No. 21-1326 (“SuperValu”), and United States ex. Rel. Proctor v. Safeway, Inc., No. 22-111 (“Safeway”).  The FCA provides that “any person who knowingly presents, or causes to be presented, a false or fraudulent claim” to the United … Continue Reading

Healthcare Companies and Companies Doing Business with the US Government – Supreme Court Appears Likely to Clarify False Claims Act (FCA) Knowledge Requirements

By Squire Patton Boggs on Posted in Compliance, False Claims Act, U.S. Supreme Court
The Supreme Court recently heard oral argument in the appeal of two False Claims Act (FCA) cases from the Seventh Circuit that called into question the level of intent, or scienter, required to establish corporate liability under the FCA for “knowingly” overbilling the government for goods or services.  The Court’s eventual decision may have widespread … Continue Reading

Dobbs Puts New Emphasis on Proactive Provider Transparency in Care Offerings

By Squire Patton Boggs on Posted in Dobbs, Physician Practice, Policy, U.S. Supreme Court
Months following the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, the reproductive health climate remains clouded with terms lawyers—not to mention patients—never like to hear: “wait and see,” “to be decided,” “gray area,” “it depends.” Perhaps nowhere is the information gap of more crucial import than at the moment a patient walks through … Continue Reading

U.S. Supreme Court Rules Unanimously in Favor of 340B Hospitals

By Estefania Borrero on Posted in 340B Program, U.S. Supreme Court
On June 15, 2022, the Supreme Court unanimously decided to reverse the judgment of the U.S. Court of Appeals for the D.C. Circuit. AHA v. Becerra, 142 S. Ct. 1896, 1906 (2022).  The issue was whether the Medicare statute affords the Department of Health and Human Services (“HHS”) discretion to vary the reimbursement rates under … Continue Reading

U.S. Supreme Court Agrees with HHS Payment Methodology for Disproportionate Share Hospitals

By Jeffrey DeBeer and Keith Bradley on Posted in HHS, Reimbursement, U.S. Supreme Court
The fight about how Medicare compensates disproportionate share hospitals (“DSH”) is one of the longest-running reimbursement disputes of recent years, and it has generated copious work for judges around the country.  In a 5-4 decision, the U.S. Supreme Court settled one piece of the conflict:  the counting of “Medicare-entitled” patients in the Medicare fraction of … Continue Reading

Supreme Court Rules that Arkansas Act 900, Affecting the Prices that PBMs Pay to Pharmacies, Is Not Preempted Under ERISA

By Kimberly Donovan on Posted in ERISA, Pharmaceutical, U.S. Supreme Court
On December 10, 2020, the Supreme Court released its decision in Rutledge v. Pharmaceutical Care Management Association. Justice Sotomayor wrote the Court’s opinion, which was joined by all Members of the Court except Justice Barrett, who did not participate. Justice Thomas filed a concurring opinion, which expressed his prior opinions that the Court’s ERISA preemption … Continue Reading

Supreme Court Ruling Limits Insurer and Employer Contraceptive Obligations

By Stacey Grundman and Doug Anderson on Posted in ACA, U.S. Supreme Court
Earlier this month the Supreme Court of the United States upheld a regulation adopted under the Trump administration significantly cutting back the requirement that insurers and group health plans provide coverage for contraceptives without cost sharing under the Affordable Care Act (ACA). Because of the ruling in Little Sisters of the Poor v. Pennsylvania, employers, … Continue Reading

Recent Supreme Court Decision Creates Basis For Challenge To HHS’s Rescission Of Anti-Discrimination Protections

By Squire Patton Boggs on Posted in ACA, HHS, U.S. Supreme Court
Most readers are likely familiar with the landmark decision issued by the U.S. Supreme Court last week, in which the Court held that Title VII prohibits discrimination on the basis of sexual orientation and transgender status. (Read more about this decision here.) That decision not only provided important clarification to the scope of protections for … Continue Reading

Supreme Court Rules in Favor of Health Insurers Under Affordable Care Act’s Risk Corridor Program

By Kimberly Donovan, Doug Anderson and John Bunch on Posted in ACA, Insurance, Payer/Insurance Reform, U.S. Supreme Court
The United States Supreme Court ruled in an 8-1 decision Monday in favor of four health insurers seeking hundreds of millions of dollars from the federal government related to the Affordable Care Act’s “risk corridor” program, reversing a lower court’s decision that Congress had suspended the government’s obligation to make such payments. Collectively, the decision was a … Continue Reading

Cracks in the Façade—Supreme Court to Reconsider “Auer Deference” Rule and Possibly Shrink Agency Leeway In Interpreting Regulations

By Keith Bradley on Posted in Regulations, U.S. Supreme Court
The playing field in a lawsuit challenging agency action is tilted toward the agency, largely by means of various deference doctrines. One of the most important has been deference to an agency’s interpretation of its own regulations. Courts have been deferring to those interpretations for decades, following a 1940s Supreme Court case, Bowles v. Seminole … Continue Reading
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