A self-funded employer spending $50M/yr on health claims often cannot produce its own claims data. The TPA holds it and charges for access. The employer is the fiduciary. This is the baseline absurdity.
The contracts make it worse. TPA shared-savings fees run 20-30% of repricing. Audit rights are written to find nothing. Data ownership clauses say the TPA owns data the employer paid to generate.
The benefits consultant is supposed to fix this. Except a large share of consultant pay comes from carriers and PBMs through overrides and retention bonuses the employer cannot see.
The 2021 Consolidated Appropriations Act banned gag clauses and required broker compensation disclosure. The FTC has filed against the big three PBMs. ERISA fiduciary suits are targeting employers who cannot produce their own plan documents.
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