Health Claims Increasingly Being Audited by Employers
The Wall Street Journal on Wednesday examined the growing trend of large employers conducting regular audits on employees' health plans and claims. Audit programs often find that 10% to 15% of employees had an ineligible dependent listed on a company plan, Michael Watson, vice president of Michigan-based audit consultant firm Budco, said. Ineligible dependents can include ex-spouses or adult children too old to qualify for inclusion. Ford Motor and DaimlerChrysler AG eliminated a combined 70,000 nonqualifying dependents from their benefit rolls in the last three years by first warning employees to correct any ineligibilities without penalty, then performing random audits to identify those who did not do so. These measures don't interfere with privacy laws, analysts say, because they verify "employee records, not personal medical or health data," according to the Journal. While companies are increasingly on the lookout for fraud by health providers and employees, such ineligible dependents are often listed for health benefits because of simple mistakes. "Most people aren't trying to beat the system," Watson said, adding, "The majority just don't understand the rules" (Fuhrmans, Wall Street Journal, 3/31).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.