The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry, protecting individuals in these plans. ERISA requires plans to provide participants with plan information, including important information about plan features and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance

The Employee Retirement Income Security Act (ERISA) protects your plan's assets by requiring that those persons or entities who exercise discretionary control or authority over plan management or plan assets, have discretionary authority or responsibility for the administration of a plan, or provide investment advice to a plan for compensation, or have any authority or responsibility to do so, are subject to fiduciary responsibilities. Plan fiduciaries include, for example, p

High-dollar claims are a persistent challenge for payers; a comprehensive payment integrity strategy can help ensure these claims are accurate and necessary. Overall healthcare spending is slated to increase exponentially over the next few years, and private payers are expected to cover a large share of the bill. The Office of the Actuary at CMS estimates national healthcare spending to grow at an average annual rate of 5.4 percent through 2028. This outpaces the average proj

Although telehealth offers many benefits for patients, it introduces operational complexities for providers and creates legitimate concerns about fraud, waste, and abuse for payers. The United States spends an average of $3.8 trillion per year on healthcare. Some estimate that fraud, waste, and abuse (FWA) costs the nation at least $114 billion annually — representing more than 3% of overall healthcare spending. So, what can payers and providers do to reduce the massive amoun

A Miami physician’s six-year, $38 million health care fraud scheme paid for luxury cars and beachfront condominiums, prosecutors say. But 63-year-old Armando Valdes won’t be doing any driving where he’ll be living next—and the accommodations are sure to be a step down. That’s because on Tuesday, a judge sentenced him to five years in federal prison after a guilty plea earlier this year. According to the U.S. Department of Justice, Valdes owned and operated Miami-based Gasiel

Starting in 2022, an estimated 2.5 million employer-sponsors of health plans are required to adopt new fee and pricing transparency requirements due to amendments to ERISA. While ERISA has focused on retirement service fees in the past, the spotlight is now on healthcare costs. The requirements fall under the Affordable Care Act (ACA) and Consolidated Appropriations Act, 2021 (CAA 2021), and affect organizations covered by the Employment Retirement Income Security Act of 1974