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UnitedHealthcare audit: Aon Hewitt finds 98.32% financial accuracy; UHC agrees to corrections and will run impact reports
Summary
Aon Hewitt's claims audit found 98.32% financial accuracy for UHC City Plan claims; UHC agreed to most statistical errors identified, recovered several overpayments and reimbursed underpayments, and committed to impact analyses for systemic issues and follow‑up corrective actions.
A statistical audit of UnitedHealthcare claims for the City Plan, presented at the Sept. 11 board meeting, found financial accuracy of 98.32 percent across a stratified random sample of 2,220 claims. Aon Hewitt explained that the audit methodology estimated a 1.68 percent mispayment rate (overpayments and underpayments combined) and described targeted follow‑up on high‑dollar and end‑stage renal disease claims.
UnitedHealthcare responded that it agreed to seven of 11 statistical errors identified in the sample and to two of four targeted audit errors. UHC reported recovered overpayments and reimbursed underpayments on those agreed errors and described system fixes for repeatable (systemic) causes. For systemic errors UHC ran impact reports that revealed additional affected claims and executed reimbursements; for discrete processor or keying errors it described internal remediation (training, side‑by‑side reviews) rather than extrapolation across the universe.
Commissioners requested written corrective‑action plans and asked that staff include the full extrapolation/impact reports in future board packets. The board discussed performance guarantees and asked staff to connect audit results to contract performance standards and any financial remedies in place with the administrator.
