Adam V. Russo | December 14, 2010
By Roy Harmon III, www.healthplanlaw.com
Thus, in a nutshell, Blue Cross lowered rates for its own subsidiary by effectively raising them for Flagstar and other self-insured plans. The letter agreements between Blue Cross and the hospitals spell out these facts in black and white.
But that does not mean that Flagstar knew about the deals. To the contrary, Blue Cross has admitted (in interrogatory responses in this case) that it never told Flagstar it had raised the Plan’s rates in order to lower them for its own subsidiary. And it appears that Flagstar was otherwise clueless about the change, because Blue Cross did not provide backup data for the bottom-line charges it sent Flagstar each month. (more…)
Category: Fiduciary Liability |
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Adam V. Russo | November 22, 2010
MyHealthGuide, www.myhealthguide.com
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 11/18/2010 www.StopLossLaw.com
Case: Hornady Manufacturing Co. v. Perico Life Ins. Co., et al. No. 8: 10CV150, in the United States District Court for the District of Nebraska, 9/22/2010) Court’s Opinion
Mr. Croft’s Comment: It never ceases to amaze me how the myth that somehow stop loss cases are ERISA cases and thus removable to federal court survives, despite overwhelming authority to the contrary. This case illustrates another futile attempt by a TPA to land a case in federal court that has no business being there. (more…)
Category: ERISA, Fiduciary Liability, Stop Loss, Third Party Administrators |
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Adam V. Russo | October 25, 2010
MyHealthGuide, www.myhealthguide.com
Washington — The U.S. Department of Labor’s Employee Benefits Security Administration today announced a proposed rule to update the definition of “fiduciary” to more broadly define the term as a person who provides investment advice to plans for a fee or other compensation.
The department’s proposed rule would amend a 1975 regulation that defines when a person providing investment advice becomes a fiduciary under the Employee Retirement Income Security Act (ERISA). The proposed amendment would update that definition to take into account changes in the expectations of plan officials and participants who receive advice, as well as the practices of investment advice providers. (more…)
Category: ERISA, Fiduciary, Fiduciary Liability, Welfare Benefit Plans |
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Adam V. Russo | April 20, 2010
Introduction
Over the course of the past several years, the value proposition of Preferred Provider Organizations (PPOs) has come under increasing scrutiny. Many have thought that if price can be controlled, health care costs can be controlled or at least mitigated. The truth is that health care costs are an intricate and complex balancing act between price and utilization (here simply defined as the number of units consumed). Attempts to control one have always resulted in equal and opposite reactions in the other. PPOs perform a necessary service for the industry, but their clout seems to be fading and with it, their value proposition has been called into question. (more…)
Category: Fiduciary Liability, Provider Reimbursement, Third Party Agreements |
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Adam V. Russo | December 28, 2009
Worried the current regulation may limit investment advice, Labor Department hopes to amend definition by June
by Jessica Toonkel Marquez, Investment News www.investmentnews.com
The Labor Department is planning to expand its definition of fiduciary under ERISA — a move that would have implications for all financial advisers that work on retirement plans. (more…)
Category: ERISA, Fiduciary Liability, Health Care Legislation |
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Adam V. Russo | November 23, 2009
With lawsuits piling up against pension plan sponsors, individual fiduciaries would do well to protect themselves against financial risks, experts say.
Randy Myers – CFO.com | US
November 19, 2009
If you are a fiduciary for your employer’s retirement savings plan, you already know that life isn’t getting any simpler. Lawsuits against plan fiduciaries are on the upswing, and some fiduciaries have been found personally liable for plan losses under ERISA, the Employee Retirement Income Security Act of 1974. (more…)
Category: ERISA, Fiduciary Liability |
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Adam V. Russo | August 11, 2009
by Tim Hull, Courthouse News Service, www.courthousenews.com
LOS ANGELES (CN) – A federal accuses Blue Cross of a wide-ranging scheme to underpay claims from out-of-network hospitals. Methodist Hospital of Southern California claims Blue Cross refuses to let it transfer patients from emergency rooms, then underpays the hospital and sticks patients with hefty bills, falsely claiming the patients “requested” to stay put. (more…)
Category: ERISA, Fiduciary Liability, Litigation |
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Adam V. Russo | July 28, 2009
In Administrative Committee of the Wal-Mart Stores, Inc. v. Gamboa, 479 F.3d 538 (8th Cir. 2007), an ERISA plan administrator brought suit seeking equitable reimbursement from a plan participant who had received a settlement from a tortfeasor. Although the reimbursement provision was contained in an SPD for a health plan, the employer had no formal written health plan. Reversing summary judgment for the participant, the Eighth Circuit held that the plan administrator reasonably construed the SPD to be on the plan document for purposes of a group health plan in the absence of any formal plan and that the reimbursement provision in the SPD was therefore enforceable. (more…)
Category: 10th, 7th, 8th, Fiduciary Liability, Plan Language, Summary Plan Description |
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Adam V. Russo | May 28, 2009
by Fred Schneyer of PLANSPONSOR, www.plansponsor.com
An Indiana manufacturer has received a mixed ruling from a federal judge in a lawsuit alleging its misdeeds in the handling of its benefits program constituted a fiduciary breach. (more…)
Category: 7th, ERISA, Fiduciary Liability |
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Adam V. Russo | July 29, 2008
The Brualdi Law Firm, P.C. has issues a press release regarding suit they have filed against Lehman Brothers Holdings, Inc. for potential violations of ERISA. The suit concerns Lehman Brother’s 401(k) plan, which comes within the purview of ERISA. Brualdi, representing members of the Plan, assert that Lehman Brothers and other administrators of the Plan may have breached their fiduciary duties, owed to plan participants. Such a breach may occur when fiduciaries fail to prudently manage plan assets. (more…)
Category: Fiduciary Liability, Litigation |
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Adam V. Russo | March 14, 2008
Roy F. Harmon III has posted recent U.S. Department of Labor legal endeavors regarding employee benefit plans on his Health Plan Law blog (http://healthplanlaw.com/). In recent months, most legal controversies regarding ERISA plans have related to plan administration and violations of fiduciary duty. Whether it is an individual plan member suing to enforce plan terms (see LaRue v. DeWolff, Boberg & Associates below) or the U.S. Department of Labor investigating irresponsible management of plan funds (the sale, for example, of a $28 million dollar plan investment for $4.5 million), fiduciary duties to plan members is at the forefront of recent ERISA law.
Category: ERISA, Fiduciary Liability |
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Adam V. Russo | July 18, 2007
On June 18, 2007, the United States Supreme Court granted a writ of certiorari to hear the appeal of this Fourth Circuit case. Their ruling will once again affect the application of ERISA. Plaintiff (employee LaRue) alleged that the administrator had failed to invest his funds as instructed, resulting in a loss. He sought monetary rewards, and both the District Court and Court of Appeals determined that the remedy he sought fell outside the scope of “equitable relief” § 1132(a)(3) of ERISA authorized. Money damages were the classic form of legal relief, absent from the list of equitable remedies available under § 1132(a)(3). Plaintiff could not recover under an equitable restitution theory since he did not allege that funds owed to him were in defendants’ possession but instead that the funds never materialized. (more…)
Category: 4th, ERISA, Fiduciary Liability, Third Party Administrators |
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Adam V. Russo | April 4, 2007
This case arose from a Plan’s failure to add an employee’s dependents to an ERISA welfare benefit plan. As a benefit of employment, the employer offered its employees health insurance. Under the Plan, the employer was both a “participant” and the “Plan Administrator.” Employees were instructed to direct their inquiries about the Plan to their employer, which acted as the general intermediary between its employees and the Insurer. (more…)
Category: Claims Procedures, ERISA, Fiduciary Liability, Plan Language, Standings, Third Party Administrators |
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Adam V. Russo | April 4, 2007
In this case, a TPA was sued by their clients (employers and those employer’s employees), for mishandling their plans’ funds. The TPA trustees in turn hoped to sue their attorney, claiming that their attorney should have notified them of the fund management issues and improper expenditures. The court found that the attorney did not have discretionary control over the assets of the plan, access to funds, or powers to administer the plans, and was therefore not a fiduciary. Even if the attorney knew of the transactions and failed to disclose them, the fund trustees would be unable to demonstrate how the attorney’s actions or lack of action proximately caused the mismanagement of the funds. (more…)
Category: ERISA, Fiduciary Liability, Third Party Administrators |
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Adam V. Russo | April 4, 2007
In this case, an employee stopped working due to a medical condition and began receiving disability benefits from her employer’s self funded ERISA plan. After two years the case was reassessed, the TPA terminated the benefits. The insured filed suit against the TPA, seeking both payment of past claims and re-instatement of future benefits. The TPA moved to dismiss arguing that it was not a proper defendant in this case because it did not have any financial responsibility to the employee. The employer and plan, the TPA asserted, were the proper defendants. The court denied the motion to dismiss, however, stating that the TPA’s discretionary power over the payment of claims made it a fiduciary to the plan and plan members. (more…)
Category: Claims Procedures, Claims Review, Coordination of Benefits, ERISA, Fiduciary Liability, Third Party Administrators |
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