08 Nov ERISA Law Breaks Into Healthcare
At Integrated Pain Management, we keep up with all the latest news in medication management, including how laws effect practices. If you’ve never heard of the Employee Retirement Income Security Act (ERISA), you probably don’t dabble much in retirement benefit laws. It’s an age-old law enacted by the President Ford administration. For most people, it’s linked to their retirement benefits. However, it’s recently picked up steam as a surprising option to help reform the United States healthcare system.
There is mention of healthcare in ERISA. In fact, ERISA’s regulations for funds used for self-insured health plans is why over 100 million people in the U.S. have health benefits. If a business has over 250 employees, these employees are considered “self-funded” simply because it’s the cheaper approach. As such, there’s over $1 trillion in yearly ERISA spending. That’s about double the amount spent each year on ERISA’s retirement plans.
ERISA is, unsurprisingly, very attractive for companies. However, it’s also gearing up to be a pitfall of liability issues. ERISA demands that “plan trustees” are diligent in their management duties. However, not many plans have an ERISA administrator at the helm. Such an administrator would harbor serious expertise to help the company navigate high-cost care areas.
This lack of expertise has led to what The Economist has called incredible waste. According to reports, $272 billion is spent on fraudulent healthcare claims in the United States every year—this spans across private and public plans alike. It’s no surprise that a close eye is being held over health plans, including ERISA.
How will the poorly managed program fare?
The more scrutiny placed on ERISA health plans, the more potential for liability. Some attorneys are getting a jump on things, with the non-profit, non-partisan Health Rosetta Institute pointing out that two of the Big Four firms have recently stopped approving audits that don’t already have ERISA risk allowances built in. It’s simply considered too big an undisclosed risk.
Perhaps the biggest shock is the idea that plan trustees and boards may know that fraud is taking place, and are not taking any action. If such circumstances exist, as is largely suggested by experts including Health Rosetta Institute, that could mean lawsuits filed by shareholders and employees who hold policies, too. When over $1 trillion dollars is being spent on health care each year, the potential for mass litigation is astounding.
ERISA hasn’t been tapped as a major source for healthcare-based lawsuits yet, but it seems key players are already gathering their ammunition and defenses. The good news? These changes won’t impact your access to the various medication and pain management techniques. Be seen quickly and get your pain treated right when you schedule a detailed evaluation at Integrated Pain Consultants by booking your appointment online or calling 480-626-2552. We also invite you to learn more about Dr. Nikesh Seth and other providers including Dr. Anne-Marie Cosijns, Dr. Lisa Sparks, Dr. Michael Givens, and our team of Nurse Practitioners.