Using a multi-pronged approach, the federal government is aggressively promoting greater transparency and understanding of costs and pricing in the healthcare and health insurance market. Indeed, last month, the U.S. Departments of Labor, Health and Human Services, and Treasury issued new proposed regulations that expand the requirements under the existing transparency regulations relating to machine-readable files. These new proposed regulations, the existing transparency regulations, the hospital price transparency initiative, and the No Surprises Act collectively represent a push and movement by the federal government to empower patients with meaningful price information.
Now, states are also taking action. On December 11, 2025, the financial officers for a number of states issued a letter requesting certain companies to undertake a detailed payment-integrity analysis of healthcare spending. These officers stated that they act as fiduciaries of public investment funds that hold shares in these companies, and they expressed an interesting in “help[ing] you better manage and oversee your company’s healthcare spending.” A few suggested steps by these states include:
- “Companies can determine whether they are overpaying for healthcare by comparing their actual charges to negotiated rates and to prices from other providers. This aligns with the DOL’s guidance that fiduciaries should compare firms based on cost, experience, and performance.”
- “The DOL states that fiduciaries should document their selection and monitoring process for healthcare vendors. Describe how you have previously audited your healthcare spending and documented those audits.”
- “Given the wide variance in hospital charges, prescription drug prices, and other medical costs, describe how you intend to use existing and newly available healthcare pricing data and vendor claims data to ensure that your plan is not overpaying for those items or services.”
Also, on December 23, 2025, four similar lawsuits were filed in federal district courts in Illinois and New York against different employers — as well as their large consulting firms — alleging the defendants, as fiduciaries, violated their duties with respect to the management and administration of accident, critical illness, and hospital indemnity insurance programs, which allegedly resulted in participants paying excessive and unreasonable premiums. There is no doubt another side to the story, and the defendants will likely aggressively defend these allegations.
All of this reflects where we are: a new era in employer-provided healthcare where there will be more information, more competition, and more disclosure. Now would be a very good time for employers to review all the pieces of their employee benefits puzzle to make sure employees and plans are getting the value they deserve.
