Baltimore Chapter Webinar: From Audit Rights to Enforceable Results: A Practical Framework for Holding TPAs and PBMs Accountable

Many benefit plans have audit rights embedded in their TPA and PBM contracts, yet struggle to translate those rights into measurable financial recoveries, operational improvements, or defensible fiduciary oversight. This session provides a deep dive into how experienced plan sponsors operationalize audit and oversight provisions for TPAs and PBMs through intentional collaboration, contract design, and coordinated audit and legal strategies. Using a real-world, anonymized case example, attendees will learn a practical framework for converting contractual audit rights into enforceable outcomes and will be provided with an experience-based checklist designed to help identify gaps in contract language, audit rights, and oversight provisions.

The session will be co-presented by the partner who leads the Self-Insured Health Plan Advisory Services Practice at WIthum and a senior partner of the ERISA practice of Nixon Peabody, both of whom serve as long-standing trusted advisors to plan sponsors of single, multiple, and multi-employer health plans which span a diverse range of industries. Together, they bring more than 50 years of combined experience working with mid-to-jumbo health plans administered by national TPAs and PBMs, including complex oversight, audit, and governance matters. Their experience includes supporting clients through audits, disputes, settlements, and litigation involving TPAs and PBMs, providing a practical and balanced perspective on how audit rights and contractual provisions operate in real-world settings.