The Chicago Business Journal article, “Who’s Watching the Money?”, extends the fiduciary obligations businesses have under the Employee Retirement Income Security Act (ERISA) to its health care benefits plans and the requirement to manage them “with the care, skill, and diligence of a prudent person.” That responsibility includes reducing waste, and cites its prevalence using results published in the Washington Health Alliance’s First, Do No Harm report. To fulfill their fiduciary obligations, the article recommends that:

• there be procedures in place to review and evaluate whether health care claim payments are being handled appropriately;
• claims be monitored regularly and advanced inferential analytic methods be used to analyze them;
• avoid conflicts of interest and use different organizations to process claims and conduct reviews, and
• there be a process to address errors quickly to avoid fraud.

Handling benefits as a fiduciary responsibility benefits the employer by making sure the money is “not wasted unnecessarily on billing errors, abusive use of the emergency department, testing for medically unlikely scenarios, or on intentional fraud.”

Read the article here.