Recent trends in excessive fee litigation indicate a shift from the previously confined realm of defined contribution plans to self-funded health plans. Over the past few months, plan sponsors have instigated three separate lawsuits against prominent health insurance providers including Aetna, Elevance Inc—previously known as Anthem Inc—and Blue Cross Blue Shield of Massachusetts. All three lawsuits against these companies were initiated in their capacities as third-party administrators, also known as TPAs. These cases scrutinize similar theories of liability.
The emergence of this new trend suggests that the landscape of excessive fee litigation might be changing to embrace self-funded health plans. Entities sponsoring such plans are urged to assess whether their participants might be subjected to unfair fees.
In the face of this rising trend, one pertinent recommendation for plan sponsors is to perform thorough audits of self-insured plan benefit claims. By conducting these audits, sponsors can accurately assess the fees charged to participants and determine if there are any discrepancies in cost.
This legal news, as reported by JD Supra and detailed by Davis Wright Tremaine LLP, highlights the growing necessity for plan sponsors to assess their practices in regard to self-funded health plans. Adequate auditing and reviewing measures are paramount to ensuring the fair and ethical administration of these plans.
As this sphere of excessive fee litigation continues to expand, it will be interesting to follow the development of these cases and their potential impacts on future health plan administration.