For employers offering benefit plans, fiduciary responsibility is not just a legal designation. Under the Employee Retirement Income Security Act of 1974, as amended, the fiduciary duty is the highest standard of care...more
A plan sponsor’s fiduciary duty to be transparent in Pharmacy Benefit Manager contracts safeguards plan participants’ interests and mitigates the risk of litigation, regulatory penalties, and reputational harm, say Hall...more
6/20/2025
/ Benefit Plan Sponsors ,
Compliance ,
Contract Terms ,
Disclosure Requirements ,
Drug Pricing ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Employer Liability Issues ,
Fiduciary Duty ,
Health Insurance ,
Pharmacy Benefit Manager (PBM)
As the healthcare industry has begun to use artificial intelligence (AI) algorithms in its claims determination process, litigation has ensued. In a recent class action lawsuit, plaintiffs claim that UnitedHealthcare used its...more
In late October, the U.S. Department of Health and Human Services (HHS) reached a settlement agreement with a medical management company based in Massachusetts over alleged HIPAA violations. Under the settlement terms, the...more
Benefits costs continue to increase globally, and in the midst of high inflation and potentially a recession, executives are exploring cost effective methods to manage their self-insured health plans without compromising the...more
1/4/2024
/ Benefit Plan Sponsors ,
Employee Retirement Income Security Act (ERISA) ,
Health Care Providers ,
Health Insurance ,
Healthcare Reform ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Popular ,
Self-Insured Health Plans ,
Surprise Medical Bills ,
TPAs
Seventeen healthcare stakeholder groups have come together to support The Value in Health Care Act, a bill that a bipartisan coalition reintroduced in Congress this summer. The bill supports a shift in the medical care...more
1/2/2024
/ ACOs ,
Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Employee Benefits ,
Employee Retirement Income Security Act (ERISA) ,
Fee-for-Service ,
Health Care Providers ,
Health Insurance ,
Healthcare ,
Healthcare Reform ,
Medicare ,
Proposed Legislation ,
Regulatory Agenda