May 09, 2016

In this article, Amanda S. Amert and Craig C. Martin examine one result of health care provider lawsuits crowding courts’ ERISA dockets.  They explain that, given the sheer number of parties and claims, “it is entirely possible that invalid claims against claim and plan administrators will be swept in with valid claims – and therein lies the rub with standing.”  They then analyze the recent opinion in Garden State Pain and Radiology, P.C. v. Horizon Healthcare Services, Inc., in which the United States District Court for the District of New Jersey grappled with the question of what Article III and statutory standing a medical services provider has to sue under ERISA.  They also offer practical steps that plans and their administrators can take to minimize the risk that courts would find providers have standing to sue for benefits under the plan.