Health Care Plan Audits

Do you know?

• That as a sponsor of a self-funded health care plan, you have a fiduciary responsibility to your plan participants. Many plan sponsors protect their health care benefits plan’s assets by engaging MedReview to perform health care plan audits that will help them meet ERISA, Sarbanes-Oxley and other regulatory requirements.
• The function of an audit is to validate the claims administrator processes and to certify that the Plan Document is being adhered to.
• A well designed audit program will help control plan costs and will make a positive contribution to the bottom line.
• That TPAs expect third party audits. TPAs have departments specifically designated to administer external audits. Your TPA or ASO agreement normally addresses your audit rights. MedReview gives your TPA an opportunity to review all audit reports and to respond. These responses are included in your final audit report.
• Your TPA’s internal health care audit program may never include a claim from your plan.
• With the exception of a Dependent Eligibility Audit, employees are seldom impacted by the results of an audit. If MedReview discovers an issue that could negatively affect a plan member, you decide whether or not to pursue the recovery of the overpayment.
• Our average Dependent Eligibility Audit determines that 6% of all dependents on your company health plan are ineligible. The lowest result we have found is 4% and the highest result we have found is 16%.