A recent excellent New York Times article explains how a change in law first effective in 2022 has quickly come to be used by out-of-network providers to obtain significant overpayments for routine medical procedures. Not stated in the article is the impact on self-funded group health plans and the sponsors of those plans. Specifically, the
A rapidly growing line of ERISA cases seeks to impose fiduciary standards of conduct—developed by courts largely in the retirement plan context—to health plan design choices. The most recent, Barbich et al. v. Northwestern University et al., No. 1:25-cv-06849 (N.D. Ill.) filed on June 20, 2025, involves a new and potentially disruptive twist: plaintiffs
A recently filed lawsuit is a good reminder that self-insured health plan fiduciaries have a fiduciary duty to ensure that their health plans are being administered according to the plan’s terms and in compliance with law, while defraying the reasonable expenses of administering the plan. In discharging this responsibility, plan fiduciaries must oversee any party
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