• Does your TPA require the hospitals to submit itemized bills, at least for bills of $10,000 or more?
• Does your TPA compare each itemized bill, line by line, with the medical records of the hospitalization to uncover overcharges? (Acquiring photocopies of those medical records can be costly, and auditing the bills requires expertise and is both labor-intensive and time-consuming.)
• How much money did your TPA recover for you last year by documenting overcharges in your hospital bills and negotiating with the hospitals to remove the overcharges and reduce the bills?
A self-funded health plan that doesn't have its auditable hospital bills audited is not only throwing money away, it's also violating Section 1104 of the Employee Retirement Income Security Act (ERISA). A fiduciary who breaches the "prudent man" standard of care in carrying out his duties is personally liable, under Section 1109, to make good any losses to the plan resulting from the breach.
The criminal penalties for willfully violating Section 1104 of ERISA, which are set forth in Section 1131, are harsh: A person may be fined up to $100,000 or imprisoned not more than 10 years, or both; a corporation may be fined up to $500,000.
If a self-funded health plan that doesn't have its auditable hospital bills audited is owned by a publicly traded corporation, it's also violating Sections 302 and 404 of the Sarbanes-Oxley Act (SOX). Internal auditing controls that allow the routine payment of bills containing overcharges are inadequate and, hence, not in compliance with the law. Those who certify financial reports that are based, in part, on inaccurate and incorrect information leave themselves open to criminal prosecution.
The penalties for violating Sections 302 and 404 of SOX, which are set forth in Section 906, are even harsher than the penalties for violating section 1104 of ERISA: A person may be fined up to $1,000,000 or imprisoned not more than 10 years, or both; if the violation is willful, a person may be fined up to $5,000,000 or imprisoned not more than 20 years, or both.
Considering the actual loss of money due to the payment of hospital bills containing overcharges and the potential financial and criminal liability due to the violation of federal laws and regulations, a self-funded health plan that doesn't have its auditable hospital bills audited is acting imprudently and flirting with danger.
Edward R. Waxman & Associates is in the business of auditing hospital bills -- in fact, we specialize in auditing hospital bills for self-funded health plans. We work strictly on a contingency fee basis, and we pay for the medical records needed to audit your bills, so in a real sense, the service we provide costs you nothing.
Finding a large hospital bill that doesn't contain any errors is like finding a four-leaf clover -- it doesn't happen very often. There is no question that your large hospital bills contain overcharges that you can't afford to pay. We uncover the overcharges and negotiate with the hospitals to get the overcharges removed and your bills reduced. We work with your TPA, so you don't have to lift a finger. All you have to do is sit back and watch the savings roll in.
Please visit the rest of our site and learn more about how we can reduce your health care costs. Have a chat with your TPA. Then send us an e-mail or call us toll-free at (877) 679-7224 and find out how to put us to work saving you money. |
