Artificial intelligence (“AI”) tools are increasingly being deployed across the employee benefits landscape: from claims administration and customer service to investment analysis and participant engagement. While these technologies promise efficiency and cost savings, recent litigation and regulatory activity underscore that the use of AI in benefits administration carries meaningful legal and fiduciary risk. Below we
On January 17, 2025, the ERISA Industry Committee (“ERIC”) filed a lawsuit, The ERISA Industry Committee v. United States Department of Health and Human Services et al. challenging the final Mental Health Parity and Addiction Equity Act (“MHPAEA”) rule published by the Departments of Labor, Treasury, and Health and Human Services (the “Departments”) in
Earlier this year, current and former participants of two ERISA-governed health plans filed complaints alleging the same novel legal theory: that plan fiduciaries violated ERISA by mismanaging the plan’s prescription drug benefits. In both complaints, plaintiffs alleged that the mismanagement was caused in part by the plans paying excessive and unreasonable fees to their respective
Imagine you’re a plan administrator who receives an angry letter from an out-of-network provider. The letter explains that before treating a plan participant, the provider called to confirm the participant’s eligibility for out-of-network coverage and to authorize treatments at certain rates under the plan. Now that treatment has been rendered, the provider is demanding payment