A recent Eighth Circuit decision regarding “cross-plan offsetting” serves as an important reminder of how ERISA’s fiduciary duties impact both employers and fiduciaries who handle claims.

The case involved the common practice of cross-plan offsetting, which occurs when a claims administrator resolves an overpayment to a provider by refusing to pay that provider for a future claim (or reducing the amount paid for that future claim)—even if the latter claim was made by a participant in an unrelated plan. Cross-plan offsetting allows claims administrators to quickly recover overpaid benefits without the time and expense associated with one-off recovery actions against providers. Defendant UnitedHealth Group (UnitedHealth) initially applied this practice among its in-network providers, but then expanded cross-plan offsetting to non-network providers beginning in 2007. This practice was challenged by two out-of-network doctors in the case at issue, Peterson v. UnitedHealth Group, Inc.

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Photo of J. Christian Nemeth J. Christian Nemeth

J. Christian (Chris) Nemeth provides legal counsel on complex commercial litigation and government investigations, including ERISA matters, financial and banking cases, business torts and breach of contract actions. Chris is the Co-Chair of the Firm’s ERISA Litigation group and works closely with the Firm’s Employee Benefits department on all types of Litigation matters, Department of Labor investigations and similar issues. Read J. Christian Nemeth’s full bio.

Richard J. Pearl

Rick Pearl focuses his practice on litigation involving the Employee Retirement Income Security Act of 1974 (ERISA). He represents companies, their benefits committees, plan administrators, fiduciaries, and service providers in complex, class-action litigation and Department of Labor lawsuits, audits, and investigations.  His particular expertise is with actions for breach of fiduciary duty and prohibited transactions. Read Rick Pearl’s full bio.