Cross-plan offsetting occurs when a valid payment from one plan is artificially reduced to "offset" an errant overpayment made to the same provider from a different plan.
Back in 2019, an Eighth Circuit Court of Appeals case offered key insight about "cross-plan off-setting." Without directly ruling on the matter, that Appellate Court sharply questioned whether ERISA permitted cross-plan offsetting. Now, a New Jersey District Court has directly held that cross-plan offsetting represents an ERISA fiduciary violation. [Lutz Surgical Partners, PLLC v. Aetna, Inc. 2021 WL 2549343 (D. N.J., June 21, 2021).]
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