Topics:

• Fraud, Waste and abuse
• ERISA Fiduciary Liability
• Third Party Administrator (TPA)
• Self-Insured Employers
• Payment Integrity
• Misaligned Incentives

In this episode, Michael introduces you to Rick Anthony, Executive Vice President for 4C Health Solutions. Join us as we discuss how 4C Health Solutions, a payment integrity solution, seeks to tackle the epidemic of healthcare fraud and waste for self-insured employers and government programs.

Here’s a glance at what we discuss in this episode:

• Rick’s extensive experience as a benefit consultant and why he joined 4C Health Solutions
• The problem with the Network Discount Model
• The definition of fraud, waste and abuse in healthcare and how it accumulates to $300 Billion annually
• How fraud can consistently go undetected within a health plan
• How employer Fiduciary Liability is also applicable to employer health plans and the current risks employers may not be aware of
• How 4C Health Solutions enables employers to uphold their ERISA fiduciary responsibility to take the steps necessary to protect the assets of employee health benefit plans
• What 4C Health Solutions provides compared to a traditional auditing firm
• 4C Health Solutions’ process for reviewing an employer’s claims history and how they identify on average 7-20% of illegitimate claims
• How 4C Health Solutions’ adjudication system prevents improper payments before they are paid without delaying the claims payment process
• The category where most of the fraud, waste and abuse claims have been identified
• The willingness of TPAs vs. other insurance carriers to work with 4C Health Solutions
• The concept of an employer owning their data and why some carriers are resistant to contract language that specifies this ownership of data
• 4C Health Solutions breaks down barriers to provide employers with independent visibility into their health benefit programs
• How 4C Health Solutions will leverage their data to help employers identify the most efficient providers who offer the highest quality care
• 4C Health Solutions’ fee structure options and typical return on investment for employers
• Barriers that 4C Health Solutions has encountered resulting in employers not implementing their service
• 4C Health Solutions’ website and contact information: 4chealthsolutions.com