Case Histories
The argument for audits
A dependent eligibility audit remains one of the most compelling strategies to obtain immediate savings and protect your health plan from unnecessary and fraudulent claim expenditures.
We've conducted more than 475 dependent eligibility audits with more than 3.8 million dependents audited. Our results to date have produced an average ROI of 2,400 percent and an average ineligible result of nearly 7 percent.
Case Study Assumptions
- Pre-Health Care Reform results are based on our own audit results.
- Cost per dependent spouse and dependent child is based on an average annual cost per employee at $5,124 per year. We assumed the same employee-only cost for the spouse and the cost-per-dependent-child at $2,050 per year, which is 40% of the employee-only figures. For post-Health Care reform we assumed health care costs increased by 10%.
- For post-Health Care Reform, we assume all dependents over age 19 will be eligible under the new laws. This is a highly conservative figure, as we know not all dependents over age 19 would be eligible, even under the PPACA regulations.
Retail Company—63,000 Enrollees
| Pre-Heath Care Reform | Post-Heath Care Reform | |
|---|---|---|
| 30,778 | Employees Covering Dependents Subject to Audit | 30,778 |
| 60,712 | Dependents Subject to Audit | 60,712 |
| $2,849 | Cost Per Dependent Per Year | $3,133 |
| 6,627 | Ineligible Dependents | 5,103 |
| 1,524 | Ineligible Dependents Over Age 19 | 0 |
| 10.92% | Percentage of Dependents Found Ineligible | 8.41% |
| $18,880,323 | First-Year Savings | $14,538,447 |
| 2489% | First-Year Return on Investment | 2061% |
Health Care Organization—9,600 Enrollees
| Pre-Heath Care Reform | Post-Heath Care Reform | |
|---|---|---|
| 5,572 | Employees Covering Dependents Subject to Audit | 5,572 |
| 11,800 | Dependents Subject to Audit | 11,800 |
| $3,614 | Cost Per Dependent Per Year | $3,975 |
| 1,323 | Ineligible Dependents | 1,173 |
| 150 | Ineligible Dependents Over Age 19 | 0 |
| 11.21% | Percentage of Dependents Found Ineligible | 9.94% |
| $4,781,322 | First-Year Savings | $4,239,222 |
| 2378% | First-Year Return on Investment | 2219% |
County Government—3,814 Enrollees
| Pre-Heath Care Reform | Post-Heath Care Reform | |
|---|---|---|
| 2,054 | Employees Covering Dependents Subject to Audit | 2,054 |
| 4,481 | Dependents Subject to Audit | 4,481 |
| $3,160 | Cost Per Dependent Per Year | $3,476 |
| 681 | Ineligible Dependents | 574 |
| 107 | Ineligible Dependents Over Age 19 | 0 |
| 15.20% | Percentage of Dependents Found Ineligible | 12.81% |
| $2,151,960 | First-Year Savings | $1,813,840 |
| 2734% | First-Year Return on Investment | 2446% |