The next “401(k) fee crisis” won’t be about retirement plans — it’s happening in healthcare. Self-funded plan sponsors face a wave of hidden costs buried in ASO, PBM, and stop-loss contracts. What appears to be routine administration often masks charges that drain plan assets and compromise compliance.

ClaimInformatics and Detego Health restore fiduciary trust with truly independent pre-payment claim review—eliminating TPA conflicts, reducing medical waste, and ensuring ERISA-aligned payment integrity.

Major networks are finally shifting on data sharing — the excuses are gone. It is the employer’s fiduciary responsibility to demand access. If a carrier or vendor refuses, and the pattern continues, you must replace them because their obstruction causes you to breach your fiduciary obligations.

At ClaimInformatics, we help plan sponsors identify hidden fiduciary risks. Before your renewal, we are offering a complimentary ASO Agreement & SPD Analysis, valued at $5,000, to the first 15 self-funded entities who schedule a call this month.

Courts are applying the same fiduciary standards used in 401(k) fee litigation to health plans.

The carrier controls claim audits. Claim reviews are fiduciary responsibilities under ERISA. Understand why reviews are crucial for safeguarding plan assets. Audits offer a snapshot of a carrier’s operations. Reviews are your fiduciary duty under ERISA. Fiduciaries must understand the difference to protect plan assets.

When claim administrators audit their own networks, conflicts arise. Independent payment integrity ensures ERISA and CAA compliance — protecting plan sponsors, members, and fiduciary accountability.

As renewal season unfolds, fiduciaries face a critical opportunity to align contracts with their ERISA duty: act solely in the interest of participants and prudently manage plan assets

As renewal season approaches, fiduciaries should carefully review contract terms and challenge “mandatory” payment integrity programs that shift costs back onto plans. If you’re being asked to pay to fix what you’ve already paid for, the time to push back is NOW!

Today, self-funded health plans are entering that same era of scrutiny. Just as 401(k) plan sponsors had to adapt to fiduciary standards, employers offering self-funded healthcare must now comply with ERISA and new mandates under the Consolidated Appropriations Act (CAA 2021). Those who fail to evolve risk legal action, regulatory enforcement, and financial harm to both the plan and its participants.

Excited to see Employee Benefit News highlighting Stephen Carrabba , ClaimInformatics, Inc. , and Jamie Greenleaf, AIF, CBFA, C(k)P,...

At ClaimInformatics, our FOCUS™ platform (Fiduciary Oversight, Compliance, and Utilization Safeguard)—powered by PAIR™ technology, Ongoing Monitoring, Pre-Pay Payment integrity and Recovery Services, and advanced analytics helps plan fiduciaries safeguard participant assets, enforce SPD protections, and achieve compliance with ERISA and the Consolidated Appropriations Act (CAA).