Broward County Commission Regular Meeting
Director's Name: Bob Melton
Department: County Auditor
Information
Requested Action
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MOTION TO ACKNOWLEDGE AND FILE Office of the County Auditor’s Review of United Healthcare Services, Inc. Claims Eligibility Status for Broward County - Report No. 26-26.
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Why Action is Necessary
What Action Accomplishes
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?County Commission
?Go Green
?MAP Broward
Previous Action Taken
Summary Explanation/Background
Based on the unique and complex nature of medical and pharmacy claims benefits administration and invoicing practices, we engaged the services of an experienced and specialized third party auditor, TFG Partners, LLC (TFG) to conduct a review of the Agreement Between Broward County and United Healthcare Services, Inc. for Administrative Management Services for Self-Insured Group Health Insurance Coverage and Benefits and Pharmacy Benefit Management Services for Broward County Benefits-Eligible Individuals (RFP No. TEC2122482P1).
The objectives of TFG’s review were to verify that all claims were correctly adjudicated and determine whether United Healthcare Services, Inc. (UHC) complied with the Agreement for plan year 2022, and through the second quarter of 2023.
We concur with TFG’s assessment, based upon their audit approach, which indicates that great majority of claims processed by UHC were adjudicated correctly for eligible members. However, a small number of paid claims were identified by TFG for former members, whose coverage was terminated by the County, or were for individuals who were not listed in the County’s eligibility files. In total, TFG identified up to $97,128 in potentially ineligible claims which should be repaid by UHC to the County, following additional review by Human Resources Division, as applicable.
We appreciate the cooperation and assistance provided by United Healthcare Services, the Human Resources Division and the County Attorney’...
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