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Aon Hewitt audit flags claim-handling errors at UnitedHealthcare; board seeks corrective action
Summary
Aon Hewitt presented a 2014 blind audit of UnitedHealthcare that found 12 errors in a stratified 220-claim sample and targeted underpayments including one corrected $208,080 denial; commissioners pressed for universe-level impact estimates and asked UHC to provide a corrective-action plan within three weeks.
Aon Hewitt presented the 2014 claims-audit results for UnitedHealthcare to the Health Service Board and identified both improvements and areas needing correction. Todd Hall of Aon outlined the methodology — a stratified 220-claim sample plus two targeted sets (10 high-dollar claims and 10 end-stage renal disease claims) — and reported 12 total errors in the sample (nine in-sample, three out-of-sample). Aon said financial accuracy and overall accuracy improved from the 2012 audit while the frequency of errors increased; the dollar amount of errors in the sample decreased by nearly $10,000.
Aon noted a large underpayment case: a manually denied inpatient claim that led to an agreed underpayment of $208,080 that UHC reprocessed prior to the audit. A second large item ($86,481.25) was removed from the error list after UHC provided additional information. Aon said six of the 20 targeted-claim errors were due to manual adjudication and that some systemic errors remain under correction. Commissioners repeatedly asked whether the sample could be extrapolated to estimate total universe impact; Aon said it does not extrapolate dollars from the sample but works one-on-one with the administrator to run reports quantifying the claim-universe impact of systemic issues.
UnitedHealthcare representative Heather Chianella told the board the carrier had reviewed Aon’s findings, disputed some errors and had already removed or corrected some items; she cautioned that the results were not yet finalized. The board directed Aon and UHC to provide an impact report and a corrective-action plan; Aon said it would request UHC’s response within three weeks and return to the board in September with updated reporting and remedial steps.
Several commissioners requested that future presentations include vendor operations and network-management representatives so board members could hear both the auditor’s findings and the carrier’s operational response. The item was a discussion item; no formal audit approval or contract action was taken at the meeting.
