Mental Health Parity (MHPAEA) Educational Interview Episode 2.

So, a full-scale investigation is going to look at not only procedural roll of the documents and plan administrators understanding of those documents but look at the operational point of view. Which is not something the agency has done in the past.

It’s not just a procedural review of the documents to make sure that the documents are in line with ERISA and the rules and regulations under ERISA but if you’re operating the plan as it is written.

That was a definite culture shift for a lot of folks at the agency because that’s just not where the focus had been. It was a shift I was excited about which was why I moved from the non-enforcement division of the employee benefits security administration as a benefits advisor to the enforcement side which is on the investigative side. Where they initiate plan level reviews and investigations as well as service level investigations to TPA level investigations. It includes everything on the group health plan side.

Very similar to the retirement plan side where on the retirement side, it was not uncommon to see a case open with a plan and a faulty service provider be found out during the investigation. Along with some of the legislation under the ACA, it gave the investigative portion of the house that dealt with health plans more teeth to go after more plans civilly and criminally.

A lot of people forget that the DOL have the authority to open joint investigations. It’s one of the reasons when talking about the DOL I stress that the DOL does not do audits; they do investigations. Audits don’t turn criminal, but investigations do. Plans and plan sponsors need to know that.