{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:31:33Z","timestamp":1787729493290,"version":"build-2784847793"},"reference-count":48,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Employers purchase health benefits for more than 60% of the nonelderly population, making employers both important custodians of employee well-being and important actors in the health care ecosystem. Because employers typically have unilateral control over health and retirement benefits, the federal Employee Retirement Income Security Act (ERISA), enacted in 1974, imposes fiduciary obligations on employers when they manage or administer benefits. We provide evidence, from a novel survey of respondents who administer or oversee health benefits for their companies, that many employers appear to neglect even the most basic of their fiduciary obligations to their employees. This neglect may help explain the poor performance of employer plans in controlling costs and providing access to health care, and it suggests that many employers may be vulnerable to liability from ERISA lawsuits.<\/jats:p>","DOI":"10.1017\/jme.2025.10159","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:49:44Z","timestamp":1757314184000},"page":"14-20","source":"Crossref","is-referenced-by-count":2,"title":["ERISA and the Failure of Employers to Perform Their Fiduciary Duties: Evidence from a Survey of Health Plan Administrators"],"prefix":"10.1017","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7172-9956","authenticated-orcid":false,"given":"Barak","family":"Richman","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00y4zzh67","id-type":"ROR","asserted-by":"publisher"}],"name":"The George Washington University"},{"id":[{"id":"https:\/\/ror.org\/04yv9ex91","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Excellence Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Monahan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/017zqws13","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Minnesota Law School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Pfeffer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00f54p054","id-type":"ROR","asserted-by":"publisher"}],"name":"Stanford Graduate School of Business"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Singer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04yv9ex91","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Excellence Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"S1073110525101599_r3","unstructured":"3. Collins, Sara R. , Roy, Shreya , and Masitha, Relebohile , \u201cPaying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer,\u201d Commonwealth Fund, October 26, 2023, https:\/\/www.commonwealthfund.org\/publications\/surveys\/2023\/oct\/paying-for-it-costs-debt-americans-sicker-poorer-2023-affordability-survey (last visited July 31, 2025)."},{"key":"S1073110525101599_r42","unstructured":"42. For example, in the Lewandowski v. Johnson & Johnson lawsuit, the court partially granted Johnson & Johnson\u2019s motion to dismiss, finding that Lewandowski had not adequately pleaded a loss resulting from the fiduciary breach. In that decision, the court did not accept the pleading that higher-than-market drug prices must have resulted in higher premiums for the plan. Lewandowski v. Johnson & Johnson, No. 24-671 (ZNQ) (RLS) (D.N.J., filed Jan. 24, 2025). In addition, the court found that Lewandowski had failed to establish individual harm because she would have hit the plan\u2019s out-of-pocket maximum for prescription drugs irrespective of whether the plan charged above-market rates. Lewandowski has the ability to file an amended complaint, and it is therefore too early to draw any strong conclusions from the case."},{"key":"#cr-split#-S1073110525101599_r24.1","unstructured":"24. Hughes v. Northwestern University, 595 U.S. 170 (2022)"},{"key":"#cr-split#-S1073110525101599_r24.2","unstructured":"Tibble v. Edison Int'l, 575 U.S. 523 (2015)."},{"key":"S1073110525101599_r15","unstructured":"15. Hughes v. Northwestern University, 595 U.S. 170, 177 (2022)."},{"key":"S1073110525101599_r32","doi-asserted-by":"crossref","first-page":"e601","DOI":"10.1097\/JOM.0000000000001967","article-title":"Employers\u2019 Role in Employee Health: Why They Do What They Do\u201d","volume":"62","author":"Pfeffer","year":"2020","journal-title":"Journal of Occupational and Environmental Medicine"},{"key":"S1073110525101599_r4","unstructured":"4. Ed Dolan, \u201cWhat\u2019s Wrong with Employer Sponsored Health Insurance,\u201d Niskanen Center, November 6 2018, https:\/\/www.niskanencenter.org\/whats-wrong-with-employer-sponsored-health-insurance\/ (last visited July 31, 2025); Hughes, Sam , Gee, Emily , and Rapfogel, Nicole , \u201cHealth Insurance Costs Are Squeezing Workers and Employers,\u201d Center for American Progress, November 29, 2022, https:\/\/www.americanprogress.org\/article\/health-insurance-costs-are-squeezing-workers-and-employers\/ (last visited Jul. 31, 2025)."},{"key":"S1073110525101599_r23","unstructured":"23. \u201cUnderstanding Your Fiduciary Responsibilities,\u201d U.S. Department of Labor, at 10; Tibble v. Edison, 575 U.S. 523, 529-530 (2015)."},{"key":"S1073110525101599_r43","first-page":"189","article-title":"Clinical Use of an Enterprise Data Warehouse","volume":"2012","author":"Evans","year":"2012","journal-title":"American Medical Informatics Association Annual Symposium Proceedings"},{"key":"S1073110525101599_r16","unstructured":"16. \u201cUnderstanding Your Fiduciary Responsibilities,\u201d U.S. Department of Labor, at 10."},{"key":"S1073110525101599_r13","unstructured":"13. See, e.g., Scalia v. Marzett, 2020 WL 4365535 (E.D. Va. 2020); Perez v. Harris, 2015 WL 6872453 (D. Minn. 2015); Perez v. Wallis, 77 F. Supp. 3d 730 (N.D. Ill. 2014)."},{"key":"S1073110525101599_r10","unstructured":"10. \u201cUnderstanding Your Fiduciary Responsibilities Under A Group Health Plan,\u201d U.S. Department of Labor, https:\/\/www.dol.gov\/agencies\/ebsa\/about-ebsa\/our-activities\/resource-center\/publications\/understanding-your-fiduciary-responsibilities-under-a-group-health-plan (last visited July 31, 2025). See also Chao v. Day, 436 F.3d 234 (D.C. Cir. 2006) (finding that the purchase of insurance with a plan\u2019s funds is a fiduciary act); Briscoe v. Fine, 444 F.3d 478, 487-88 (6th Cir. 2006) (holding that company directors act as fiduciaries when they select third party administrator for a health plan); Coyne & Delany Co. v. Selman, 98 F.3d 1457, 1465 (4th Cir. 1996) (concluding that the power to appoint, retain, or remove plan fiduciaries, such as an insurer, constitutes \u201cdiscretionary authority\u201d over plan management and administration, making such decisions fiduciary in nature); Acosta v. Chimes District of Columbia, Inc., 2019 WL 931710 (D. Md. 2019) (characterizing the selection of a third party administrator for a health plan as a fiduciary function)."},{"key":"S1073110525101599_r36","volume-title":"Employer Health Benefits: 2023 Annual Survey","author":"Claxton","year":"2023"},{"key":"S1073110525101599_r7","unstructured":"7. 29 U.S.C. ch 18."},{"key":"S1073110525101599_r40","unstructured":"40. Claxton et al., Employer Health Benefits 2024 Annual Survey."},{"key":"S1073110525101599_r1","unstructured":"1. Bureau of Labor Statistics, US Department of Labor, Employer Costs for Employee Compensation (September 2023), 4, table 1, https:\/\/www.bls.gov\/news.release\/pdf\/ecec.pdf."},{"key":"S1073110525101599_r41","unstructured":"41. Claxton et al., Employer Health Benefits: 2023 Annual Survey."},{"key":"S1073110525101599_r38","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.0706"},{"key":"S1073110525101599_r22","unstructured":"22. 29 U.S.C. \u00a7 1108(b)(2)(B). This requirement applies only where the amount of compensation is reasonably expected to equal or exceed $1,000."},{"key":"S1073110525101599_r33","first-page":"00469580209814","article-title":"The Secret Menu in Health Care: A Cash Market for Imaging in California","volume":"57","author":"Epstein","year":"2020","journal-title":"INQUIRY: The Journal of Health Care Organization, Provision, and Financing"},{"key":"S1073110525101599_r29","unstructured":"29. \u201cUnderstanding Your Fiduciary Responsibilities,\u201d U.S. Department of Labor, at 10."},{"key":"S1073110525101599_r28","unstructured":"28. See Lewandowski v. Johnson & Johnson, No. 24-671 (D. N.J. Jan. 24, 2025) (explaining the overlapping requirements of ERISA standing and Article III standing in the context of a health plan fiduciary claim)."},{"key":"S1073110525101599_r9","unstructured":"9. 29 U.S.C. \u00a7 1002(21)(A)."},{"key":"S1073110525101599_r34","unstructured":"34. \u201cUnderstanding Your Fiduciary Responsibilities,\u201d U.S. Department of Labor, at 10."},{"key":"S1073110525101599_r27","unstructured":"27. 29 U.S.C. \u00a7\u00a7 1109, 1132(a)(2), (3) & (5)."},{"key":"S1073110525101599_r19","unstructured":"19. Information Letter 02-19-1998."},{"key":"S1073110525101599_r37","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.0481"},{"key":"S1073110525101599_r21","unstructured":"21. Lack of compliance with these disclosure requirements remains relatively widespread. See, e.g., \u201cHospital Price Transparency Enforcement Updates,\u201d Centers for Medicare & Medicaid Services, April 26, 2023, https:\/\/www.cms.gov\/newsroom\/fact-sheets\/hospital-price-transparency-enforcement-updates (last visited Jul. 31, 2025) (reporting that as of April 2023, CMS had issued more than 730 warning notices for noncompliance)."},{"key":"S1073110525101599_r44","unstructured":"44. Allen, Marshall , \u201cIn Montana, a Tough Negotiator Proved Employers Don\u2019t Have to Pay So Much for Health Care,\u201d ProPublica, October 2, 2018, https:\/\/www.propublica.org\/article\/in-montana-a-tough-negotiator-proved-employers-do-not-have-to-pay-so-much-for-health-care (last visited October 15, 2024)."},{"key":"S1073110525101599_r11","unstructured":"11. See Beck v. PACE Int\u2019l Union, 551 U.S. 96, 102 (2007)(noting that the selection of an insurer to pay defined benefit plan benefits is a fiduciary function)."},{"key":"S1073110525101599_r39","volume-title":"Prices Paid to Hospitals by Private Health Plans","author":"Whaley","year":"2024"},{"key":"S1073110525101599_r18","unstructured":"18. In re Unisys Sav. Plan Litig., 74 F.3d 420, 435 (3d Cir. 1996); Brock v. Tricario, 768 F.2d 1351 (11th Cir. 1985)."},{"key":"S1073110525101599_r45","unstructured":"45. Hansard, Sara , \u201cEmployers Still Struggle to Access Insurers\u2019 Health Cost Data,\u201d Bloomberg Law, February 22, 2024, https:\/\/news.bloomberglaw.com\/daily-labor-report\/employers-still-struggle-to-access-insurers-health-cost-data (last visited October 15, 2024)."},{"key":"S1073110525101599_r20","unstructured":"20. Information Letter 02-19-1998. It may also be possible to characterize high fees as a prohibited transaction under ERISA \u00a7 408(b)(2)(A), 29 U.S.C. \u00a7 1108(b)(2)(A), which prohibits a plan from entering into a contract for services except where \u201cno more than reasonable compensation is paid therefor.\u201d However, the scope of those prohibited transaction rules is currently pending before the U.S. Supreme Court. See Cunningham v. Cornell Univ., 2024 WL 439127 (Oct. 4, 2024) (granting certiorari). As a result, we limit our analysis of the issue to the duty of prudence."},{"key":"S1073110525101599_r12","unstructured":"12. 29 U.S.C. \u00a7 1104(a)(1)(B)."},{"key":"S1073110525101599_r26","unstructured":"26. Singer et al., \u201cAn Absence of Accountability.\u201d"},{"key":"S1073110525101599_r30","unstructured":"30. \u201cUnderstanding Your Fiduciary Responsibilities,\u201d U.S. Department of Labor, at 14."},{"key":"S1073110525101599_r31","volume-title":"Competition in Health Insurance: A Comprehensive Study of U.S. Markets","author":"Guardado","year":"2023"},{"key":"S1073110525101599_r2","unstructured":"2. Keisler-Starkey, Katherine , Bunch, Lisa N. , and Lindstrom, R.A. , Health Insurance Coverage in the United States: 2022, Report P60-28 (US Census Bureau, US Department of Commerce, September 2023)."},{"key":"S1073110525101599_r47","unstructured":"47. Wille, Jacklyn , \u201cFlood of 401(k) Fee Lawsuits Spur Wave of Early Plaintiff Wins,\u201d Bloomberg Law, April 5, 2022, https:\/\/news.bloomberglaw.com\/employee-benefits\/flood-of-401k-fee-lawsuits-spur-wave-of-early-plaintiff-wins (last visited July 31, 2025)(finding that more than 170 such lawsuits had been filed since 2020)."},{"key":"S1073110525101599_r17","unstructured":"17. \u201cInformation Letter 02-19-1998,\u201d U.S. Department of Labor, February 19, 1998, https:\/\/www.dol.gov\/agencies\/ebsa\/about-ebsa\/our-activities\/resource-center\/information-letters\/02-19-1998 (last visited October 15, 2024)."},{"key":"S1073110525101599_r5","first-page":"234","article-title":"Hiding in Plain Sight: ERISA\u2019s Cure for the $1.5 Trillion Health Benefits Market","volume":"42","author":"Monahan","year":"2025","journal-title":"Yale Journal on Regulation"},{"key":"S1073110525101599_r46","unstructured":"46. \u201cRetirement-Plan Class Action Payouts by Large Corporations Top $6 Billion,\u201d Good Jobs First, April 3, 2019, https:\/\/goodjobsfirst.org\/erisa_prrel\/. (last visited October 15, 2024)."},{"key":"S1073110525101599_r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2025.118131"},{"key":"S1073110525101599_r8","unstructured":"8. Lockheed Corp. v. Spink, 517 U.S. 882, 890 (1996)."},{"key":"S1073110525101599_r6","unstructured":"6. Lewandowski v. Johnson & Johnson, No. 1:24-cv-00671 (D.N.J. Feb. 5, 2024); Navarro v. Wells Fargo & Co., No. 0:24-cv-03043 (D. Minn. July 30, 2024); Stern v. JP Morgan Chase & Co., No. 25-2097 (S.D.N.Y. Mar. 13, 2025)."},{"key":"S1073110525101599_r35","unstructured":"35. \u201cUnderstanding Your Fiduciary Responsibilities,\u201d U.S. Department of Labor, at 10."},{"key":"S1073110525101599_r14","unstructured":"14. Donovan v. Mazzola, 716 F.2d 1226, 1232 (9th Cir. 1983); Bussian v. RJR Nabisco, Inc., 223 F.3d 286, 300 (5th Cir. 2000)."}],"container-title":["Journal of Law, Medicine &amp; Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1073110525101599","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T11:24:16Z","timestamp":1774437856000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1073110525101599\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":48,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1073110525101599"],"URL":"https:\/\/doi.org\/10.1017\/jme.2025.10159","relation":{},"ISSN":["1073-1105","1748-720X"],"issn-type":[{"value":"1073-1105","type":"print"},{"value":"1748-720X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,8]]}}}