Court Case Addresses Cross-Plan Offsetting

“The court strongly hinted that the practice violated ERISA’s fiduciary duty rules, including the requirement that plan assets of one plan be used for the ‘exclusive purpose’ of benefiting individuals covered by that plan.”

Long-Awaited ‘Cross-Plan Offsetting’ Case Increases Risk for Employers, Insurers

“[To recover disputed overpayments from an out-of-network provider,] an alleged overpayment relating to one health plan from one employer is ‘offset’ by modifying the amount which is paid by a different health plan of a different employer…. The court noted that nothing in the plan documents allowed UHC to conduct cross-plan offsetting…. Then, the court strongly hinted that the practice violated ERISA’s fiduciary duty rules, including the requirement that plan assets of one plan be used for the ‘exclusive purpose’ of benefiting individuals covered by that plan.” [Peterson v. UnitedHealth Group Inc., No. 17-1744 (8th Cir. Jan. 15, 2019)]
Quarles & Brady LLP

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