There is waste, abuse, and fraud throughout the health care system. The real question is “How much waste, abuse, and fraud is there in your employee health plan?”
If your plan is like most: up to 5% of claims and 12% of enrollees may not be your liability. This translates into over $1,000 in waste, abuse and fraud for every employee you cover.
Why Audit your Self-Funded Plan?
Health care delivery, payment, and administration all have waste and abuse. Audits pinpoint that waste and abuse for your plan. We also support follow-up actions to maximize plan recoveries.
Without an independent audit, plan fiduciaries, managers, and advisors are left to react to the payors’ versions of what happened in the past; often received too late to do anything.
If you don’t audit, you expose yourself and others to liability and risk. Self-funded plans must comply with regulatory requirements that vary by type of employer, workforce, and enrollment demographics. All must be able to pass the “prudent person” test that requires fiduciaries and other responsible persons – as individuals – to show they have shown proper oversight of plan functioning and financing. Audits make sure you pass that test.
Audits save you money, give you control and protect you. That’s why you audit.