Diablo West Physical Therapy & Sports Medicine

United Healthcare continues to violate ERISA and harm providers and patients by cross-plan offsetting with their Medicare Advantage plans. What is cross-plan offsetting? See below: Cross-plan o?setting is a so-called “bulk-recovery practice” that UHC has used for a number of years to collect overpayments made to providers. Under ERISA, a health plan may recover overpayments made to a participant or service provider by requesting a refund or reducing future benefits or payments. However, with cross-plan o?setting, a third party administrator (TPA) seeks to recover an overpayment to a healthcare provider under one health plan that it administers by underpaying or “o?setting” an amount owed to the same provider under a di?erent health plan it administers. Essentially, the TPA uses the assets of one health plan to pay or reimburse benefits provided under another health plan in violation of ERISA’s exclusive benefit rule. If an insurer TPA uses assets from a self-insured plan to reimburse overpayments in a fully insured plan, the TPA’s actions may violate ERISA’s prohibition against self-dealing. In addition, when cross-plan o?setting occurs, a healthcare provider may balance bill a patient because the patient’s plan has not paid the provider’s bill in full. This risk is higher with out-of-network healthcare providers that do not have contracts with the TPA. Despite multiple court rulings and the Department of Labor citing that cross-plan o?setting is a violation of ERISA sections 404 and 406 respectively, UHC continues to be a bad actor. We have escalated this issue to UHC's legal team and their stance is that they are going to keep doing it until penalized enough to stop. If this is happening to your practice, notify the Department of Labor (DOL phone #: 866-444-3272) and instruct your affected patients to do so as well. Feel free to reach out to us for more specific details.

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