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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources, investment management and real estate. 

 

Established in 1996, The Wagner Law Group has 28 attorneys engaged exclusively in employee benefits, estate planning and employment law. Six of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

 

Washington, D.C.

Tel: (202) 969-2800

  Fax: (202) 969-2568

800 Connecticut Ave., N.W.

Suite 810

Washington, D.C. 20006

 


Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

 

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

 

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
100 South 4th Street, Suite 550
St. Louis, MO  63102 

 

 

www.wagnerlawgroup.com

 

 

 

March 30, 2017

 

 Health and Welfare Law Alert

 

 

 

      Federal Court Says Insurer's Practice

   of Cross-Plan Offsetting is Illegal

 

 

 

 

 

The United States District Court for the District of Minnesota recently determined, in Peterson v. UnitedHealth Group, Inc., that a health insurer's practice of "cross-plan offsetting" was illegal because the terms governing the impacted health plans did not authorize the practice.

 

Background. Cross-plan offsetting is a practice employed by health insurers and TPAs to recoup alleged overpayments made to service providers for patients from one health plan by reducing or eliminating payments for patients from different plans also serviced by the insurer or TPA.

 

Facts. The plaintiffs in Peterson, a class action lawsuit, were health care providers that the defendant-insurer/TPA alleged had been overpaid for services provided to certain patients covered under a self-insured health plan that was administered by the defendant. To recoup these overpayments, the defendant reduced or eliminated future payments it made to the plaintiffs for services they provided to patients covered under different self-insured group health plans also administered by the defendant. 

 

In response, the plaintiffs sued, alleging that the defendant had wrongfully failed to pay them for providing covered health services to patients enrolled in health plans administered by the defendant.

 

District Court. In hearing the matter, the district court reviewed the terms of the health plans at issue to determine whether they authorized the defendant's practice of cross-plan offsetting. The district court determined that the health plans' terms provided no such authorization for the defendant's practice. The district court commented that the defendant's interpretation of the plans to allow cross-plan offsetting was "inherently unreasonable" and created "gross conflicts of interest."

 

Moreover, the district court ruled that the defendant had violated its fiduciary duty as the plans' administrator by failing to obtain the plan sponsors' consent to reduce or eliminate payments from the health plans to offset the overpayments made from different health plans.

 

Takeaway from Peterson. The district court's ruling in Peterson only relates to whether the terms of the health plans at issue authorized cross-plan offsetting and not whether the practice was a violation of ERISA fiduciary duties. Nonetheless, the district court noted its skepticism about whether ERISA permits cross-plan offsetting, especially in the context of an insurer that both insures certain plans and acts as TPA for other self-insured health plans.

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.