Audit finds $79K in payment errors
Audit Issue
Benefits for the evaluation and testing of sleep disorders were clearly limited by the Plan to a maximum of $3,000 per plan year.
Audit Finding
We confirmed that benefits were paid beyond the maximum amount on each of the 10 samples we isolated for on-site review. Additionally, we noted that the same types of payment errors were reported as the result of a previous audit we performed for the same Plan.
Third-Party Administrator Response
The claims administrator agreed that overpayments were made, and that system edits requested after the first audit had not been completed in a timely manner. Subsequent to the audit, an accountable team was assigned by the administrator to implement effective procedures to correct its system.
Financial Error
The overall effect of these payment errors amounted to more than $79,000.00.