Rick Anthony | 4C Health Solutions

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

About the Host, Michael Menerey

Michael Menerey is a Senior Vice President and Benefits Consultant with one of the largest Employee Benefits Brokerage & Consulting firms in the country. He is a partner in the Employee Benefits Practice and works in the Los Angeles office.

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