Mass. Laborers’ Health & Welfare Fund v. Blue Cross Blue Shield of Mass.

The First Circuit affirmed the judgment of the district court dismissing this action Mass. Laborers’ Health & Welfare Fund v. Blue Cross Blue Shield of Mass against Blue Cross Blue Shield of Massachusetts (BCBSMA) and dismissing the Massachusetts Laborers’ Health and Welfare Fund’s (Fund) three claims brought under the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. 1001 et seq., holding that there was no error. For sixteen years, BCBSMA served under contract as a third-party administrator for a self-funded multi-employer group health plan administered by the Fund.

In 2021, the Fund brought this suit alleging that, in violation of its contractual obligations, BCBSMA paid medical providers in amounts exceeding rates that BCBSMA negotiated with a network of medical providers. The district court dismissed the action under Fed. R. Civ. P. 12(b)(6) on the grounds that the Fund had failed plausibly to allege that BCBSMA was an ERISA fiduciary with respect to the actions subject to the Fund’s complaint. The First Circuit affirmed, holding that the Fund’s argument that BCBSMA was a fiduciary failed.Mass. Laborers’ Health & Welfare Fund v. Blue Cross Blue Shield of Mass