Health Plan Investigations

This document is about providing guidance on health case openings and initial reviews for group health plans and service providers under the Employee Retirement Income Security Act (ERISA). It covers the criteria for opening a health investigation, the types of investigations (plan-level and service provider), the key elements of Part 7 violations, and the sources and methods for case identification. The document also outlines the investigative activities, including document requests and subpoenas, that may be undertaken as part of a health plan investigation.