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Health Plan Administrator's Cross-Plan Offsets Were ERISA Prohibited Transactions and Violated Fiduciary Duty of Loyalty
Thomson Reuters / EBIALink to more items from this source
July 22, 2021

"The court explained that, in a pooled account, overpaying claims under Plan A decreases the funds available to pay claims under Plan B, making Plan A's interests adverse to Plan B's. Thus, when the administrator reduced payments under Plan B to recoup funds for Plan A, it engaged in a prohibited transaction ... The court also agreed that the administrator's use of cross-plan offsetting violated the duty of loyalty." [Lutz Surgical Partners PLLC v. Aetna, Inc., No. 15-2595 (D.N.J. Jun. 21, 2021)]

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