Welcome to Issue #26 of The Health Plan Compliance Advantage. Most newsletters don’t make it past Issue #2—so reaching this milestone feels like a moment worth acknowledging.
Over the past six months, I’ve shared stories, lawsuits, case studies, and strategies focused on one core idea:
Employer-sponsored health plans are governed by fiduciary duties that are real, enforceable—and increasingly risky to ignore.
To everyone who’s read, shared, or just silently nodded along—thank you. This community has turned the written word into real-world conversations, and I’m incredibly grateful for your support.
This week, I’m reflecting on the biggest lessons so far—and what they signal about where we’re headed and what you need to do.
Because awareness without action is still a breach.
How Did We Get Here?
Twenty-five newsletters.
Thousands of readers.
And an alarming trend:
Most health plan fiduciaries are flying blind—and the consequences are no longer hypothetical.
What I’ve seen again and again: smart, well-meaning leaders caught off guard. Not because they didn’t care—but because they thought the status quo was the safest and most convenient option.
Now, they’re showing up in lawsuits, media exposés, and regulatory actions. Turns out, doing nothing isn’t neutral—it’s dangerous.
The 5 Biggest Lessons You Can’t Ignore
From health plan governance to pharmacy benefit reform, here’s what stands out:
Most fiduciaries don’t realize they’re fiduciaries. If you approve budgets, select vendors, or oversee performance—you’re not just “involved.” You’re on the hook.
Too many plans trust vendors instead of overseeing them. Delegation is not a defense. If your vendor’s actions are not in the participant’s best interest, you’re responsible.
Procurement and oversight are often weak—or undocumented. Could you defend your decisions under oath? Most cant.
Compliance is reactive, not strategic. Most organizations wait until a renewal—or a lawsuit—before asking tough questions. By then, the damage is done.
The biggest risk isn’t doing the wrong thing. It’s doing nothing. And letting conflicts of interest, waste, and overpayments pile up.
25 newsletters. Hundreds of lessons. 5 you can’t ignore
If you’ve been following for a while, you already see the warning signs. But awareness isn’t protection.
✅ ERISA doesn’t care what you meant to do. It cares what you did and documented.
Here’s where to start:
Confirm whether you’re a named, appointed, or functional fiduciary
Ensure your board authorized a fiduciary committee and a written charter
Request and review full compensation disclosures from your broker, TPA, and PBM
Audit contracts for gag clauses, excessive fees, and misaligned incentives
Ask yourself: Would a judge believe we acted in the participants’ best interest?
Final Thought and Sneak Peak
🛡️ “The best fiduciaries aren’t just compliant. They’re proactive.”
That’s why I’ve partnered with the Validation Institute to support employers ready to move from conflicted incumbents to vetted, transparent vendors—backed by a guarantee.
Sneak Peak: In the coming weeks, we’ll also launch the Validated Fiduciary™ Certification Program.
Validated Fiduciary Certification
More than just a badge. It’s a proactive legal defense strategy that says: we did our job. Built to help leaders:
Prove process compliance
Reduce liability
Improve plan performance
Until then—thank you for reading. And thank you for leading!
🤝 Share this issue with someone responsible for a health plan
💸 SPECIAL OFFER: Newsletter subscribers receive 10% off any Validation Institute service. Use code FIDUCIARY10 at checkout.
validationinstitute.com
📬 PAY IT FORWARD: Feel free to forward this offer to your broker, PBM, or other vendors. Don’t hesitate to tell them you will favor validated vendors as part of your modernized procurement processes. Strong compliance and better benefits begin with validation.
Don’t be a bystander. Change the status quo and reap the benefits of The Health Plan Compliance Advantage.
