The client is working with the administrator on follow-up meetings based on audit findings and carefully schedules performance reviews to assure that identified and agreed upon fixes are implemented. Several of the performance expectations have become part of the new service agreement, with performance guarantees tied to reasonable standards. One administrator has been provided preferred status based on, among other factors, strong payment accuracy performance, and thus lower overall cost to the client.
The last audit cycle identified over $314,000 of overpayments in the limited on-site sample review, with an additional $700,000 in potential overpayments from claims related to these sample claims.
Quote from a recent administrator report:
“HMO Plan- We have completed our review of the file for the one individual who was identified
as having potential overpayments valued at $106,955.23. We located claims which were overpaid, and initiated our recovery efforts. At this time we have recovered $101,496.45.”