The value of medical claim auditing for self-funded health plans is affirmed in many ways each year – it always pays to review what’s happening with your third-party processor. The latest example to make TPA oversight a topic in the news is a class-action lawsuit filed against UnitedHealthcare Group (“UHCG”) over out-of-network payments. The giant health carrier (and claim processor for self-funded plans) is accused of systemically underpaying benefits for out-of-network claims in violation of ERISA’s fiduciary obligations.
