Model Optimal Care Warns Self-Funded Plans That the December Gag Clause Attestation Rests on Contracts Most Haven’t Read

PHOENIX, AZ, UNITED STATES, October 5, 2026 /EINPresswire.com/ — Model Optimal Care today urged self-funded health plan sponsors to read their service provider contracts before they sign this year’s gag clause prohibition compliance attestation, which is due to the federal Departments by December 31. The attestation is a statement about contract language, not a statement of intent, and the sponsor who signs it is the party on the hook for what the contracts actually say.

MOC Fiduciary Intelligence, the company’s AI platform at fiduciaryIQ.ai, reads those agreements and flags restrictive language against the governing provision, with the citation attached. Every new account starts with a free one-month trial that includes one comprehensive fiduciary report and score, and requires no credit card to start.

The duty is large and the money behind it is larger. National health spending reached $5.7 trillion in 2025, by CMS estimate. Researchers put 25 to 30 cents of every healthcare dollar in the waste column, on the order of $1.7 trillion a year. Self-funded plans cover 67 percent of covered workers, 80 percent at firms with 200 or more workers, and more than 160 million Americans. Every one of those plans files the same attestation, and every sponsor signs it holding the same fiduciary duty.

WHAT THE ATTESTATION ACTUALLY ASKS
The Consolidated Appropriations Act of 2021 added parallel provisions at Internal Revenue Code section 9824, ERISA section 724, and Public Health Service Act section 2799A-9. They took effect December 27, 2020. They bar a plan from entering an agreement with a provider, a provider network, a third party administrator, or another service provider that restricts the plan from three things: disclosing provider-specific cost and quality information to participants, beneficiaries, sponsors, and referring providers; accessing de-identified claims and encounter data on request; and sharing that information with a business associate. The first attestation was due December 31, 2023. One is due by December 31 of each year after that, covering the period since the last one, and it is filed through the CMS HIOS portal.

THE QUESTION IS ABOUT LANGUAGE, NOT INTENT
A sponsor who has never read the clause cannot answer the question the attestation asks. Restrictive language rarely announces itself. It sits inside a data access section that limits claims extracts to an agreed format, inside a confidentiality clause that treats negotiated rates as the vendor’s trade secret, inside an audit provision that lets the vendor pick the auditor, or inside a subcontracted network agreement the sponsor has never seen. Each one reads as ordinary commercial drafting. Read against the statute, each one can defeat the attestation the sponsor is about to sign.

A TPA FILING DOES NOT MOVE THE DUTY
Many self-funded plans let a TPA attest on their behalf. The federal submission instructions are direct about what that arrangement does and does not do. If a self-funded plan enters such an agreement and the TPA fails to submit, the plan violates the requirement. The filing can be delegated. The responsibility cannot. A sponsor who assumes the TPA handled it, and never confirmed, bears the exposure alone.

EVIDENCE FROM THE DOCUMENTS
MOC-FI reads the record rather than asking the sponsor what the record says. Load the administrative services agreement and its amendments, the PBM contract, the stop-loss policy, the network agreements, and the gag clause attestation itself. The platform scores the plan against 32 fiduciary indicators drawn from the Model Optimal Care framework, ERISA, and the CAA, returns a score on a scale from 1 to 10, and cites the governing provision behind each finding. Sponsors can ask questions in plain language and get answers cited to the page in their own contracts. In one Model Optimal Care sample comprehensive review, the platform identified $5.23 million in savings opportunity, with $1.24 million recoverable immediately. That figure is the company’s own sample, not independent research, and no two plans return the same number.

AVAILABILITY
Start the free one-month trial, including one comprehensive fiduciary report and score, no credit card required, at fiduciaryIQ.ai. The full feature set and the scoring methodology are at modeloptimalcare.com. The framework behind the indicators is set out in Model Optimal Care: End U.S. Healthcare Waste, One Health Plan at a Time (Manuscripts Press, May 2026).

ABOUT MODEL OPTIMAL CARE
Model Optimal Care is a Phoenix, Arizona company building artificial intelligence and analytics solutions for self-funded health plans, spanning fiduciary oversight, medical and pharmacy claims analysis, waste detection, and CAA compliance. It also publishes The MOC Brief and operates the CP-MOC certification program. Visit modeloptimalcare.com to learn more.

ABOUT THE FOUNDER
Jude Odu is Founder and Principal of Model Optimal Care, LLC and author of Model Optimal Care: End U.S. Healthcare Waste, One Health Plan at a Time. He has spent more than 25 years in healthcare technology and data science, and previously founded Health Cost IQ and Health Data Intelligence.

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