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When large corporate or nonprofit employers sponsor their employee benefits, they put millions of dollars on the line. Healthcare plans are among the most expensive, and it's why medical claims auditing and pharmacy claim reviews matter so much. There is a fiduciary responsibility to pay claims accurately, and with outside firms handling it, auditing is the most effective way to conduct oversight. It provides an objective third-party review of all payments and their accuracy, or not. Given the many factors affecting plans today, it's... more

Employer-funded health plans have made news twice recently in the legal arena. Some sponsors have taken their claim administrators to court, and class action lawsuits on behalf of members are planned. In each case, a healthcare audit may figure into the causes for action of defense against them. An independent review of claim administration and payments is essential to confirming reports from third-party administrators or pharmacy benefit managers. As they pay thousands of claims weekly or monthly, errors can occur, even with the mos... more