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.
