UBA Provides Guide for DOL Health Plan Audits

The likelihood of a group health plan audit by the Department of Labor is increasing, UBA says.

United Benefit Advisors (UBA) released a resource guide meant to walk employers through the process of an audit of group health plans from the U.S. Department of Labor (DOL).

The white paper, “Don’t Roll the Dice on Department of Labor Audits,” includes information about how to prepare for an audit, the best way to acclimate staff to the audit process, what the DOL wants, and the most important elements of complying with requests.

“When it comes to a DOL audit, prevention is certainly warranted, but it’s not a matter of ‘if’ you’re ever going to get audited, it’s a matter of ‘when,’” says Jeff Hadden, Partner at LHD Benefit Advisors, a UBA Partner Firm.

Hadden says 12 of his clients received DOL audits of their group health plans in the past 20 years. Of those 12, nine went through the audit process in the previous two years. “That’s a significant increase and a harbinger that more audits are likely to come from the DOL,” says Hadden.

According to Hadden, it takes approximately one to two weeks to properly prepare for an audit, depending on the size of the business and how well they are organized. Part of that preparation is building an audit binder with known documents.

Josie Martinez, Senior Partner and General Counsel at UBA Partner Firm EBS Capstone, says the following steps should be taken if a health plan sponsors has been selected to be audited:

  • Call the DOL Phone Number: Call the DOL phone number listed on the letter and request an extension. If granted, this additional time is vital and should be used to your advantage to help prepare.
  • Get Specific Information About the Audit: Find out what the focus of the investigation will be. While it will usually review an organization’s entire history, there will often be one thing of particular focus (e.g. the claims and appeals process). Important questions to ask include: What are the time periods of the review? What are the names of any people who the auditor wants to interview? “You only want to provide exactly what the auditor wants and nothing more,” says Martinez.
  • Call Your Attorney and Your Broker: “Last, but certainly not least,” says Deanna Johnson, Director of Compliance at UBA Partner Firm Benefit Insurance Marketing, “call your attorney and your broker’s office and give them a heads-up.”

By planning ahead, conducting a self-audit, educating appropriate staff, and resolving any issues, an employer should be able to face a DOL audit with absolute confidence, UBA says.

Download the white paper at http://bit.ly/1FZrNZj.