performance audit

Today’s health and benefits environment has brought rising healthcare costs and fewer health plan vendor choices. With the addition of increased regulatory constraints, performance audits should be a fundamental element in your cost control toolbox.


Why does your organization need a performance audit?


Every health plan sponsor faces issues of compliance, fiduciary responsibility and, of course, annual budgetary requirements. When administrative issues cause claims and compliance penalties to balloon unnecessarily, the cost can be astronomical.


A health plan audit can tell you where your benefits and administration are on target and where they’re off the mark. At an average cost of less than 0.1% of most companies’ overall benefit spend – far less than the expense of high-cost claims – an audit can clarify:


  • Trends in high-cost medical and pharmacy claims: High-cost claims put your organization’s coverage at risk. An effective audit can pinpoint the source of high-cost claims and guide your risk mitigation strategies.
  • ERISA and fiduciary obligation: Plan sponsors have a fiduciary obligation to ensure that health plans are working in members’ best interest. You may have an implicit responsibility to audit your health plan coverage.
  • Sarbanes–Oxley duties: Before signing off on the benefits portion of a balance sheet, an organization has the responsibility to periodically audit health, medical, dental or pharmacy benefits payments. An audit validates your statement.
  • Compliance validation: Internal or external independent auditors frequently ask about a healthcare audit. Are you confident that what you are reporting on financial statements provides an accurate representation of what’s been paid? A plan audit validates compliance and identifies areas that need refinement.



Average return on investment among Mercer Performance Audit clients*

Performance audit solutions


How is your claims administrator performing? What areas are creating a problem, and what solutions are possible? To answer these questions, we offer a full array of health plan performance audits, including:


  • Plan administrator audit of medical, pharmacy and dental plans
  • Health care claims audit with statistical sampling, 100% audit for anomalies, and high-cost claims audit
  • Benefit implementation assessment for medical, dental and pharmacy benefits
  • COBRA administration
  • Appeals administration
  • Member service operations audit



          *Results may vary


Contact us

Find out how Mercer’s performance audit solutions can keep your employee health and benefits program moving forward.

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