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Hidden Fees in Self-Funded Health Plans: Reading Between the Lines
The next “401(k) fee crisis” will not be about retirement plans. It is happening in healthcare. Courts are applying the fiduciary standards from 401(k) fee litigation to self-funded health plans, where hidden costs are buried in ASO, PBM, and Stop-Loss contracts. Learn where these fees hide and how to protect your plan.
Jun 263 min read


The Hidden Costs of Cross-Plan Offsetting for Self-Funded Plans
Cross-plan offsetting costs self-funded plans millions in hidden fees. Learn how bulk recovery practices create fiduciary risks and what sponsors can do.
Dec 18, 20252 min read


When 'shared savings' really means shared conflicts and the importance of transparency, independent oversight, and true accountability
Excited to see Employee Benefit News highlighting Stephen Carrabba, ClaimInformatics, Inc., and Jamie Greenleaf, AIF, CBFA, C(k)P, Fiduciary In A Box, contributed article entitled "Benefits Think: When 'shared savings' really means shared conflicts." The article highlights that shared savings may sound like a cost-containment measure, but they often mask conflicts of interest. The Tiara Yachts case shows why fiduciaries must demand transparency, independent oversight, and tru
Sep 29, 20251 min read


Aetna & Optum Settle “Dummy Codes” Case for $8.4M: What Fiduciaries Should Learn.
Fiduciaries need the people, process, and technology to ensure plan oversight. After nearly a decade of litigation, Aetna Life Insurance Company and OptumHealth Care Solutions have agreed to pay $8.4 million to settle allegations that they concealed administrative fees inside claims using so-called “dummy codes.” 🚩 Allegations Plaintiff Sandra Peters argued that Aetna and Optum: Directed providers to submit claims with “Administrative Add-On Services.” Masked Optum’s adminis
Sep 19, 20252 min read


Self-Funded Plans Face Rising Fiduciary Pressures — and New Opportunities for Accountability
Without transparency and access to THEIR data, plan sponsors risk breaching fiduciary duty under ERISA and the CAA. The 2025 Pulse of the Purchaser Survey confirms what many of us already know: affordability threats are not easing. For the fifth straight year, employers rank drug prices, hospital costs, and high-cost claims as the top drivers of unsustainable healthcare spending For self-funded plans, these challenges bring heightened fiduciary obligations. According to the
Sep 11, 20252 min read

The Fascinating Story of Billions of Dollars Going Missing When the Back Office Pays Health Care Bills
Audacity Podcast - Play now

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs
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Inside Big Health Insurers' Side Hustle
Tradeoffs Podcast - Play now
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