From a drug manufacturer that contributes money to a non-profit Copay Assistance foundation and then steers Medicare patients taking their drugs to that foundation to a diagnostic lab that pays doctors for every blood test they refer, disguising the payments as “processing and handling fees”, there seems to be no end to the costly schemes plaguing our healthcare system. What is an employer group to do?
For starters, use partial self-funding to provide health benefits to your workers – even if your group is small. It’s the only way to know where your health plan dollars are going from month to month and year to year. Choose an independent TPA to design your plan, manage costs and advocate for your members. This way, you and your plan will have a dedicated, experienced team looking out for your best interests, rather than those of a provider or a large health plan (who may both be part of the same organization).
We can’t keep fraud and abuse out of the healthcare system. But by paying claims in strict accordance with your plan document, providing special handling for members with a serious condition or chronic illness, and helping your members choose high quality, high value providers, we can do everything in our power to keep it from impacting your health plan directly.