Cross-plan offsetting costs self-funded plans millions in hidden fees. Learn how bulk recovery practices create fiduciary risks and what sponsors can do.

For many plan sponsors, the word “audit” suggests penalties or after-the-fact corrections. In reality, independent claims reviews are about prevention, transparency, and protecting plan assets — not punishment.

When claim administrators audit their own networks, conflicts arise. Independent payment integrity ensures ERISA and CAA compliance — protecting plan sponsors, members, and fiduciary accountability.

As renewal season approaches, fiduciaries should carefully review contract terms and challenge “mandatory” payment integrity programs that shift costs back onto plans. If you’re being asked to pay to fix what you’ve already paid for, the time to push back is NOW!

Florida Women's Care, one of the largest women’s health providers in the state, revealed troubling allegations of systematic overbilling and upcoding designed to pad private equity profits. These practices come at a steep cost to patients and health plans.

Martand Bhatt's parents weren't sure he needed immediate medical care when the energetic toddler burned his hand on the kitchen stove one...

Code Creeping or Upcoding. It's all the same and the damage this has to employer plans across the country far exceeds the impact to...

Don’t be surprised if the U.S. Department of Health and Human Services continues the COVID-19 public health emergency in mid-July, based...

High-dollar claims are a persistent challenge for payers; a comprehensive payment integrity strategy can help payers ensure higher dollar...

Although telehealth offers many benefits for patients, it introduces operational complexities for providers and creates legitimate...

A Miami physician’s six-year, $38 million health care fraud scheme paid for luxury cars and beachfront condominiums, prosecutors say. But...