Health Plan Fiduciaries: Ways to Avoid Litigation Based on High Fees

Trucker Huss

Presenters:  Mary Powell, Joe Faucher, Dylan Rudolph, & Alaina Harwood

The Consolidated Appropriations Act, 2021 (CAA) requires a new level of transparency on pricing and fees charged to health plans. Fiduciaries need to understand what to do with this additional information — and how to use it to negotiate lower fees.

We will discuss provisions of the CAA that fiduciaries can use to try to obtain information needed to determine if health plans are being overcharged for services. We will also address potential litigation risk facing fiduciaries responsible for monitoring fees charged to health plans. Topics will include:

• Disclosure Obligations for Broker and Consultant Services
• Prescription Drug and Health Cost Reporting Requirements
• Transparency in Coverage Rule
• Gag Clause Prohibitions in Vendor Agreements
• Potential Fiduciary Litigation Risk and Examples of Recent Cases

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