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»  Posts By   June 2016 

“Test Case” Arbitrations an Effective Alternative to Class Action Arbitrations for Independent Pharmacies Challenging PBM Audits

Class action arbitrations were one of the most powerful tools in a lawyer's arsenal to help independent pharmacies force nation-wide changes to abusive PBM auditing conduct. A class action arbitration is a procedural device that permits one or more independent pharmacies to file and prosecute a claim on behalf of a larger group of independent pharmacies. Without class action arbitrations, independent pharmacies looking to challenge abusive PBM practices are forced...

Health Plans File RICO Suit Against Valeant and Philidor Over “Secret” Relationship Signaling Continued Scrutiny of Pharma-Pharmacy Relationships

On May 27, 2016, Valeant Pharmaceuticals was hit with a proposed class action accusing the drug company and its executives of violating the Racketeer Influenced and Corrupt Organizations (RICO) Act.  The suit – filed by two health care funds – alleged that Valeant fraudulently schemed to block Valeant's drugs from competition and ensure their selection and coverage through a "secret network of captive pharmacies" who acted uniquely to push Valeant's...

Federal Trade Commission Establishes Personal Liability for the Actions of Medical Board Members

Seeking to address questions raised by a recent U.S. Supreme Court decision that establishes personal liability for medical professionals acting in their roles as Medical Board members, the Federal Trade Commission has issued guidance explaining how Medical Boards can regulate their own professions without violating antitrust law. In N.C. State Bd. Of Dental Exam’rs v. FTC, 135 S. Ct. 1101 (2015) the U.S. Supreme Court ruled that that it was illegal...

Vermont Enacts Law Addressing Sudden Drug Price Hikes Impacting the Manner of How Pharmaceutical Manufacturers Set and Report Prices for Drugs

On June 3, 2016, the Governor of Vermont signed into law a bill that would highlight drugs on which the State spends significant amounts of money, with the goal of regulating the drug manufacturers' setting of acquisition and list prices. Under the law, pharmaceutical companies producing those specific drugs could be fined up to $10,000 if the State determines that Wholesale Acquisition Cost (WAC) rises too quickly and the company...

Fourth Circuit to Rule on Two Novel Questions of Law Concerning the False Claims Act

Permissibility of Using Statistical Sampling to Calculate Damages for Allegedly Medically Unnecessary Services and the Government's Power to Veto a Proposed Qui Tam Settlement of Non-Intervened Claims In U.S. ex rel. Brianna Michaels and Amy Whitesides v. Agape Senior Community, et al., the Fourth Circuit has been called upon to address two False Claims Act (FCA) issues of first impression: (1) whether statistical sampling can be used to calculate damages where the fraud alleged is the rendering...
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