Bloomberg Law
June 23, 2021, 3:44 PM

Aetna’s Cross-Plan Insurance Clawbacks Violate ERISA, Judge Says

Jacklyn Wille
Jacklyn Wille
Legal Reporter

Aetna Health violates federal benefits law when it engages in a common insurance billing practice for recouping overpaid medical claims called cross-plan offsetting, a federal judge in New Jersey ruled.

Aetna breached its fiduciary duties as a plan administrator under the Employee Retirement Income Security Act when it used cross-plan offsetting to recoup money paid to Lutz Surgical Partners PLLC, the U.S. District Court for the District of New Jersey held. The offsetting also constitutes an impermissible prohibited transaction under ERISA, Judge Brian R. Martinotti of said.

The dispute revolves around cross-plan offsetting, a billing practice aimed at recouping overpayments ...