Sign up to save your podcasts
Or
Share The Gloves Are Off!
Share to email
Share to Facebook
Share to X
Share to email
Share to Facebook
Share to X
Or
The Gloves Are Off!
In a lawsuit that has shed light on the risks associated with self-funded healthcare plans, Kraft Heinz has accused Aetna and Willis Towers Watson of failing to act in a fiduciary capacity and protect them from overcharging for inpatient open heart surgery. Fraud, Waste, and Abuse (FWA) is an ever-present issue in the healthcare industry, and Slingshot Bills can help detect it. As employers look for attractive options to insurance for their employees, it is essential that they are aware of their rights and make sure their insurance companies are acting in their best interests. Not only does this ensure that employees are getting the most out of their healthcare plans, but it also safeguards employers from overspending and ultimately getting taken advantage of.
Episode Outline:
(00:00:02) Kraft Heinz Lawsuit
(00:03:58) Carrier Fraud Incentives
(00:08:13) Kraft Heinz Lawsuit
(00:12:36) Fraud, Waste, and Abuse
(00:16:47) Self-Funded Plans
Quotes:
(00:03:41) If they're looking to make an example, if they're looking to be the face of other employers, mostly smaller employers, who are struggling even more with this than they are, who don't have the sophistication to understand they're getting screwed, nor the resources to do anything about it, even if they did, then we have a shot.
(00:07:32) But think about this dynamic even more. If they allow fraud, waste and abuse, that means the hospital is getting more money, which is keeping the hospitals happy.
(00:11:45) If you are acting as one, then you are one. And if you agree to be held to the same standards of care, then you have to be held to the same standards of punishment when it doesn't occur.
(00:16:31) We don't give our plan partners enough credibility, but yeah, we've partnered with some fantastic people and organizations in the industry.
(00:17:26) Don't, uh, don't get yourself up in a lawsuit, but sue when your employees are being taken advantage of and that's what they're doing.
Social Post:
Are you tired of the same old healthcare conversations? Tune in to the Healthcare Hangover podcast with David Contorno and Emma Fox to hear a fresh take on the healthcare industry. From discussing the multi-layer problems of lawsuits against Aetna to the incentives for fraud, waste, and abuse, you won't want to miss this episode! #HealthcareHangover #Aetna #Fraud #Waste #Abuse
Are you tired of being taken advantage of by healthcare providers? Tune into the latest episode of The Healthcare Hangover to learn how employers and brokers can help protect you from medical billing errors. 97% of hospital bills have errors, and we'll discuss the responsibility of Willis Towers Watson and how they could have prevented Kraft Hines from meeting their fiduciary responsibility. Don't miss out on this important conversation! #HealthcareHangover #MedicalBillingErrors #FiduciaryResponsibility
Are you curious about how to save money on healthcare costs? Tune into the latest episode of The Healthcare Hangover podcast to learn how Kraft Heinz is trying to get paid and how you can audit your own healthcare plan for fraud, waste, and abuse. David Contorno and Emma Fox discuss how to lower the severity and frequency of claims and how to save double digits on healthcare costs. Don't miss out on this valuable information! #TheHealthcareHangover #HealthcareCosts #FraudWasteAndAbuse
Blog Post:
Kraft Heinz is currently in the midst of a lawsuit filed against their insurance company, Aetna, for not acting in a fiduciary capacity. This is a complex situation that has been in the news recently, and it is important to understand the implications of the lawsuit for employers and healthcare consumers.
David Contorno and Emma Fox plan to write to Kraft Heinz and convince them to let David give expert testimony before the trial begins. They have done an analysis of their clients' fraud, waste and abuse percentages, and they have found that on average, 10% of total spend in a plan is fraud, waste and abuse, and their average fraud, waste and abuse was 0.8% of spend. This is an order of magnitude of about 92% better or less than the average plan. The average error in billing results in a $2,000 overpayment per error, while their plan was $180 per error.
Aetna is responsible for acting as a fiduciary for their clients, even though the client is self-funded. Carriers look for improper claims and identify fraudulent, wasteful, and inaccurate claims. When carriers find an overpayment or a claim that shouldn't have been paid, they pay themselves a finder's fee and only give the employer a portion of what they recover. Hospitals have more leverage over carriers than brokers or employers do, and certainly more than patients do. Carriers don't want to hassle the hospitals and don't want to have to ask for money back, so they have audit restrictions. Most provider contracts at the hospital level have audit prohibitions. Pediatricians have to put more information on a claim form for a Strep test than a hospital has to put for a weeklong.
Kraft Heinz is claiming that Aetna engaged in fraud or concealment to prevent and interfere with Kraft Heinz's efforts to investigate and understand Aetna's conduct. They were looking for a big claims dump to see what was being billed, what was being allowed, and if it was in line with the terms that they're supposed to be. Every decision that's made in a company's 401k must be for the benefit of the participants and must not allow the employer or other participants to abuse the plan. Kraft Heinz is looking to make an example and be the face of other employers, mostly smaller employers, who are struggling even more with this than they are.
Willis Towers Watson is mentioned in the complaint, but they are neither the defendant nor the plaintiff. Willis Towers Watson did not have a fiduciary responsibility but could have prevented Kraft Hines from meeting their fiduciary responsibility. The Administrative Services Agreement between Kraft and Aetna stated that Aetna would discharge their obligations with the level of reasonable care which a similarly situated service provider or plan administrator under ERISA as applicable, would exercise under similar circumstances in connection with fiduciary powers and duties. Aetna agreed to observe the standard of care and diligence required of a fiduciary under ERISA section 404 AIB.
The outcome of the lawsuit will depend on who is driving it at Kraft Heinz and how much they know about what's going on, as well as their motivation in doing it. Kraft cannot have a Kraft employee on the jury due to a conflict of interest. Employers should be running checks and balances to ensure their employees are not taken advantage of. David and Emma suggest using Slingshot Bills to analyze self-funded plans.
Empowered has been tackling healthcare for five years and has found a sweet spot in what works and what doesn't. 97% of hospital bills have errors, which are always in favor of the provider. Healthcare can be complicated and there is always a hangover. Employers should take the time to thoroughly understand their healthcare plan and make sure that they are not taking advantage of their employees. This episode of the podcast provided helpful insight into the complexities of healthcare and the importance of staying informed.
Episode Links
Connect with Emma Fox
- Website
- Emma’s Website
Connect with David Contorno
- Website
Other Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
View all episodes
By David Contorno, Emma Fox
5
99 ratings
In a lawsuit that has shed light on the risks associated with self-funded healthcare plans, Kraft Heinz has accused Aetna and Willis Towers Watson of failing to act in a fiduciary capacity and protect them from overcharging for inpatient open heart surgery. Fraud, Waste, and Abuse (FWA) is an ever-present issue in the healthcare industry, and Slingshot Bills can help detect it. As employers look for attractive options to insurance for their employees, it is essential that they are aware of their rights and make sure their insurance companies are acting in their best interests. Not only does this ensure that employees are getting the most out of their healthcare plans, but it also safeguards employers from overspending and ultimately getting taken advantage of.
Episode Outline:
(00:00:02) Kraft Heinz Lawsuit
(00:03:58) Carrier Fraud Incentives
(00:08:13) Kraft Heinz Lawsuit
(00:12:36) Fraud, Waste, and Abuse
(00:16:47) Self-Funded Plans
Quotes:
(00:03:41) If they're looking to make an example, if they're looking to be the face of other employers, mostly smaller employers, who are struggling even more with this than they are, who don't have the sophistication to understand they're getting screwed, nor the resources to do anything about it, even if they did, then we have a shot.
(00:07:32) But think about this dynamic even more. If they allow fraud, waste and abuse, that means the hospital is getting more money, which is keeping the hospitals happy.
(00:11:45) If you are acting as one, then you are one. And if you agree to be held to the same standards of care, then you have to be held to the same standards of punishment when it doesn't occur.
(00:16:31) We don't give our plan partners enough credibility, but yeah, we've partnered with some fantastic people and organizations in the industry.
(00:17:26) Don't, uh, don't get yourself up in a lawsuit, but sue when your employees are being taken advantage of and that's what they're doing.
Social Post:
Are you tired of the same old healthcare conversations? Tune in to the Healthcare Hangover podcast with David Contorno and Emma Fox to hear a fresh take on the healthcare industry. From discussing the multi-layer problems of lawsuits against Aetna to the incentives for fraud, waste, and abuse, you won't want to miss this episode! #HealthcareHangover #Aetna #Fraud #Waste #Abuse
Are you tired of being taken advantage of by healthcare providers? Tune into the latest episode of The Healthcare Hangover to learn how employers and brokers can help protect you from medical billing errors. 97% of hospital bills have errors, and we'll discuss the responsibility of Willis Towers Watson and how they could have prevented Kraft Hines from meeting their fiduciary responsibility. Don't miss out on this important conversation! #HealthcareHangover #MedicalBillingErrors #FiduciaryResponsibility
Are you curious about how to save money on healthcare costs? Tune into the latest episode of The Healthcare Hangover podcast to learn how Kraft Heinz is trying to get paid and how you can audit your own healthcare plan for fraud, waste, and abuse. David Contorno and Emma Fox discuss how to lower the severity and frequency of claims and how to save double digits on healthcare costs. Don't miss out on this valuable information! #TheHealthcareHangover #HealthcareCosts #FraudWasteAndAbuse
Blog Post:
Kraft Heinz is currently in the midst of a lawsuit filed against their insurance company, Aetna, for not acting in a fiduciary capacity. This is a complex situation that has been in the news recently, and it is important to understand the implications of the lawsuit for employers and healthcare consumers.
David Contorno and Emma Fox plan to write to Kraft Heinz and convince them to let David give expert testimony before the trial begins. They have done an analysis of their clients' fraud, waste and abuse percentages, and they have found that on average, 10% of total spend in a plan is fraud, waste and abuse, and their average fraud, waste and abuse was 0.8% of spend. This is an order of magnitude of about 92% better or less than the average plan. The average error in billing results in a $2,000 overpayment per error, while their plan was $180 per error.
Aetna is responsible for acting as a fiduciary for their clients, even though the client is self-funded. Carriers look for improper claims and identify fraudulent, wasteful, and inaccurate claims. When carriers find an overpayment or a claim that shouldn't have been paid, they pay themselves a finder's fee and only give the employer a portion of what they recover. Hospitals have more leverage over carriers than brokers or employers do, and certainly more than patients do. Carriers don't want to hassle the hospitals and don't want to have to ask for money back, so they have audit restrictions. Most provider contracts at the hospital level have audit prohibitions. Pediatricians have to put more information on a claim form for a Strep test than a hospital has to put for a weeklong.
Kraft Heinz is claiming that Aetna engaged in fraud or concealment to prevent and interfere with Kraft Heinz's efforts to investigate and understand Aetna's conduct. They were looking for a big claims dump to see what was being billed, what was being allowed, and if it was in line with the terms that they're supposed to be. Every decision that's made in a company's 401k must be for the benefit of the participants and must not allow the employer or other participants to abuse the plan. Kraft Heinz is looking to make an example and be the face of other employers, mostly smaller employers, who are struggling even more with this than they are.
Willis Towers Watson is mentioned in the complaint, but they are neither the defendant nor the plaintiff. Willis Towers Watson did not have a fiduciary responsibility but could have prevented Kraft Hines from meeting their fiduciary responsibility. The Administrative Services Agreement between Kraft and Aetna stated that Aetna would discharge their obligations with the level of reasonable care which a similarly situated service provider or plan administrator under ERISA as applicable, would exercise under similar circumstances in connection with fiduciary powers and duties. Aetna agreed to observe the standard of care and diligence required of a fiduciary under ERISA section 404 AIB.
The outcome of the lawsuit will depend on who is driving it at Kraft Heinz and how much they know about what's going on, as well as their motivation in doing it. Kraft cannot have a Kraft employee on the jury due to a conflict of interest. Employers should be running checks and balances to ensure their employees are not taken advantage of. David and Emma suggest using Slingshot Bills to analyze self-funded plans.
Empowered has been tackling healthcare for five years and has found a sweet spot in what works and what doesn't. 97% of hospital bills have errors, which are always in favor of the provider. Healthcare can be complicated and there is always a hangover. Employers should take the time to thoroughly understand their healthcare plan and make sure that they are not taking advantage of their employees. This episode of the podcast provided helpful insight into the complexities of healthcare and the importance of staying informed.
Episode Links
Connect with Emma Fox
- Website
- Emma’s Website
Connect with David Contorno
- Website
Other Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.