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Claims audits identify errors and penalties for UMR and VIA; board accepts findings and penalties
Summary
A fourth‑quarter random‑sample audit found decreased financial accuracy and some claim turnaround shortfalls for UMR (CTI penalty ~$49,149.60); a separate VIA HRA audit found five errors and a $10,000 penalty. The board accepted both audits and applied the penalties; vendors described remediation and staffing steps.
Independent auditors presented quarterly claim audits for vendors that administer PEP plans and recommended remedial steps and penalties for missed performance guarantees.
CTI presented a UMR claim audit covering 04/01/2025–06/30/2025. Auditors reported approximately $73 million in medical and dental payments across ~245,000 claims during the quarter, and a stratified random sample and operational review. The contractors met the 14‑day turnaround guarantee but fell short of some financial‑accuracy metrics and the 99% within‑30‑day guarantee.…
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