Auditing Health Care Benefits: How to Manage Costs & Minimize Risk

As an increasing number of organizations become more and more active in assessing their rising health care costs, internal auditors are being asked to get involved in the evaluation and control of health benefits administration. Unfortunately, health benefits are complicated, technical, and often down-right confusing for auditors embarking on their first audits of this area.

Auditing Health Care Benefits: How To Manage Costs & Minimize Risk, by Michael A. Paolella, helps to pave the way for internal auditors by offering them a "comprehensive road map" for performing a respectable health care administration audit. Paolella's concise and successful step-by-step approach highlights strategies that auditors can use to help their companies manage costs by minimizing risk.

Paolella begins with a brief, but satisfactory, introduction to the health care industry. He explores the reasons behind rising health care costs and describes the steps being taken by corporate America to control them. He then introduces the audit process itself by discussing the team concept of working together with human resource personnel and other corporate members in performing audits. He even constructs a factual overview of some of the obstacles that may emerge when auditors deal with human resource personnel during a health benefits audit.

In his overview of the audit process, Paolella covers topics that have typically been overlooked by the many benefit consultants who follow the statistical claims audit approach. Some human resource personnel accept statistical claim audits as the sole basis for evaluating...