Audits for Self-Funded Plans

[Guest retraite]

My company has a self funded health plan. There is no trust. Claims are paid out of general disbursements account of the company. There are more than 100 participants. Is an audit required? Even if so, does anyone really do this? Thanks.

[leevena]

An audit is not required, but something you might want to consider. You have fiduciary responsibility for the plan, even if you outsource the administration to a third party. Yes, there are many organizations that audit. You should try asking for references from people you trust, such as other employers, your benefit consultant, etc.

[Guest Benefit Audit Consultant]

Most of my clients audit every 1 to 3 years. If an audit turns up any issues, then a deeper investigation may be warranted. If you want some general information about claim audits you can refer to our blog. http://www.chapmankelly.com/blog/tag/medical-claim-audit/