Since 2011, our Audit Finding of the Month provides insights into what drives BMI to help organizations uncover who and what their healthcare dollars are being spent on.
Post-implementation audits act as a critical ‘second check’ for new health plan designs. In this case study, BMI reviewed 1,100+ medical and prescription claims scenarios, confirming accuracy, uncovering discrepancies, and helping the plan sponsor protect compliance and member trust.
A large healthcare employer saved nearly $3 million in one year simply by verifying who actually belonged on their health plan. With over 11,000 dependents enrolled, a Dependent Eligibility Verification Audit uncovered hundreds of ineligible individuals, driving nearly 3,000% ROI. This real-world case study shows how proactive verification not only reduces waste but strengthens compliance and protects long-term benefit sustainability.
A focused prescription claims audit revealed $464K in systemic overspending, eligibility lapses, and compliance issues stemming from SPD misalignment. By reviewing $183K in sampled claims, BMI Audit Services helped a public sector health plan identify errors, reduce financial risk, and strengthen fiduciary oversight.
Discover how a multi-employer health plan used a dependent eligibility audit by BMI Audit Services to save $2.42 million in just one year. Learn the process, results, and benefits of auditing dependent health coverage.
An employer in the healthcare field with 4,000 employees engaged BMI to conduct an implementation audit of their new third-party administrator (“TPA”) to ensure accuracy of their claims processing prior to going live for the new plan year.
A major retail employer suspected their medical claims weren’t being processed correctly—and they were right. With the help of BMI Audit Services, they uncovered $28K+ in overpayments due to errors in copayments, coordination of benefits, and plan exclusions.
The Consolidated Appropriations Act of 2021 (CAA) significantly impacts group health plan fiduciaries by eliminating restrictions on data transparency and requiring fiduciaries to monitor their service providers. The Department of Labor (DOL) mandates that plan sponsors ensure plan resources are used correctly, with failure to uphold fiduciary duties leading to severe penalties. This white paper explores the implications of gag clause prohibitions, the importance of claims audits, and how plan sponsors can comply with these regulations to safeguard their fiduciary responsibilities.
