A group of large self-funded employers — including Aramark, Kraft Heinz, Whirlpool, W.W. Grainger, Ralph Lauren, and Sterling Jewelers — recently sued the ASO of a major carrier. They allege that, as their third-party administrator, the carrier:
- Approved improper, false, or inflated claims with little human review
- Overpaid providers and failed to recover those overpayments
- Retained a portion of the difference on repriced claims
- Limited access to complete claims data needed for independent audits
The complaint also raises concerns about cross-plan offsetting and applying less rigorous claims scrutiny to self-funded plans than to the carrier’s own fully insured business. The administrator has publicly disputed the allegations.
For self-funded employers, the suit highlights the importance of claims oversight and access to data. As your TPA, MedBen never forgets that we work for you, not the other way around.
We’ve stated it before, but it bears repeating: It’s YOUR data. That’s why MedBen clients have multiple avenues to access their claims data, including monthly reporting, quarterly plan reviews, and the MedBen Analytics employer dashboard.
As your claims payor, we proactively review claims through our physician-led forensic claims review process. This process identifies inaccurate charges and other payment issues, helping ensure plans pay the right amount for the right care.
Our bottom line: Your money belongs to you… not part of it, but all of it.
For questions about your claims data, contact your Account Management team. For compliance or privacy questions, contact MedBen’s Director of Compliance & Human Resources Erin Kelly.