Self-Insured Groups
Hospital Bill Overcharges in Self-Insured Groups
In a "60 Minutes" exposé (March, 2006), Dan Rather revealed that hospitals were charging uninsured patients 400%-500% more than they were charging insurance companies.
We have found that healthcare providers also have a clear pattern of overbilling self-insured health plans. Our auditors have identified significant overcharges in the hospital billing of publicly-traded corporations, privately held corporations, City/County Governments, and School Districts.
There is a common misconception that Third Party Administrators (TPAs) verify the accuracy of employees' hospital bills, prior to issuing payment. This is not the case. In reality, TPAs review eligibility and pay claims. They do not have the time, resources, expertise, or contractual obligation to review the accuracy of every billed charge.
Please review the fine print in your TPA agreement.
You will probably find the following:
1. The TPA has no contractual obligation to verify the validity of the invoice.
2. The TPA has no contractual obligation to verify the accuracy of the invoice.
3. The TPA has a "hold harmless" clause (In other words, if the TPA makes excessive payments on your behalf, you cannot hold the TPA responsible for your losses).
The Cost of Healthcare Fraud:
- Healthcare fraud is costing Americans approximately $170 billion per year, according to a report by the National White Collar Crime Center (based on GAO estimates).
- Estimates (confirmed by an Equifax study) are that over 90% of hospital bills contain errors--most of which are overcharges, in the hospitals' favor.
- According to a CMS study of 160,000 Medicare hospital bills, the average hospital bill contains overcharges of 9.3%.
Why have an Accu-Rate hospital bill audit?
1. You and your employees may have been overcharged for healthcare services. In fact, you may have been charged for healthcare services that have not even been provided. If this is the case, your company, your employees, and your shareholders are losing valuable funds that could be spent more effectively.
2. We find the errors that TPAs overlook. Our firm represents self-insured groups in identifying hospital bill errors and securing credits, and/or adjustments. We supplement the services of Third Party Administrators (TPAs).
3. We find that nine out of ten employee hospital bills contain overcharges that can be eliminated. This represents money that belongs to your Plan and your employees. In our Pre-Payment Reviews, we identify overcharges, before the client pays the hospital bill. Our goal is to ensure that your Plan pays only for valid and accurately priced healthcare charges.
4. Our firm finds so many hospital billing errors that we work on a contingency basis; that is, you pay a percentage of the amount we save for your Plan. Your only investment is (a) any fee that the hospital/medical office may charge for copying records; (b) the cost of shipping the bills to our office, and (c) a small retainer, to be applied toward savings achieved by our audit.
Your Next Step:
Please check your monthly Exception Reports. These documents list the hospital bill overcharges that your internal audit systems are identifying and correcting. If your current systems are not (a) identifying errors in 90% of your employees' hospital bills and (b) identifying an average overcharge of at least 10%... you're probably being overcharged for healthcare.
We can help you improve your current systems, to ensure that you pay only for valid and accurate healthcare charges.