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Employee healthcare costs are rapidly escalating, and many companies have converted to self-funded health insurance plans. Under these plans, companies either contract directly with insurance companies or Third-Party Administrators (TPAs) to administer the processing of their healthcare claims for medical, vision, dental and/or prescriptions. The processing of claims should be consistent with your company's healthcare benefit plans.

It is estimated that the sheer volume of claims and other factors can cause overpayment error rates ranging from 10% to 20% of overall costs per year for companies. These overpayments can significantly impact your company's profitability and shareholder value and potentially create a competitive disadvantage by needlessly increasing operating costs.

The problem is that few companies have any kind of recurring audit to identify problem situations. By ignoring this problem, companies are at risk of compromising their workforce. How, you might ask? Consider that due to competitive pressures, your company is passing on all, or a portion of, anticipated cost increases in self-insured health plan costs to your employees. Now, think about how much happier your employees would be without cost increases or, better yet, receiving enhanced benefits. This scenario is apt to happen if the foresight and execution of your plan was being administered correctly and discovery of hidden savings and/or recovery opportunities were recognized.

There are also Sarbanes-Oxley standards to be considered. Most insurer or TPA contracts insulate themselves from the liability of processing your claims incorrectly, which means if there is an underpayment and it is discovered, the company is held accountable. Imagine finding out that your company has underpaid claims for years and now has to pay the difference; would that be material to your bottom line?

If you want to sleep knowing that your selfinsured plan is healthy, you need a paid-claims audit. Amper typically recovers three to five times their professional fees charged. The Amper Healthcare Group will evaluate your Plan Document to test a statistically valid sample of paid-claims in medical, dental and/or prescription areas. Once a valid conclusion is reached, Amper reports these results to the company. Amper assists companies, by presenting in a formal report, our methodology, findings, and request for refund. Amper can also assist companies in negotiating a refund with the insurer or TPA.

The benefits of a paid-claims audit clearly make sense, both in the form of refunds and enhanced benefit design and controlled employee benefit costs. An audit also helps to ensure that management and the board fulfill their fiduciary responsibility, not only to the health plan, but also to maximize shareholder value by focusing on operating costs.