Sentinel and Benefits Management Group

The Sentinel Group, a leader in health claim fraud and abuse management services, has agreed to provide health insurance claim anti-fraud services to clients of Benefit Management Inc. (BMI), a Kansas-based third party administrator. BMI administers the benefit plans for state high-risk pool in Kansas, Iowa, Oklahoma, Alaska, Washington state and New Hampshire, as well as for employers and associations.

The Sentinel Group will review and evaluate all medical claims submitted to BMI for possible fraud or abuse. It's estimated that up to 10 percent of all healthcare claims that insurance companies and third party administrators receive are fraudulent, abusive or erroneous. By conservative estimates, that's more than $200 annually for each American. Through its screening and investigation of suspect billing practices, The Sentinel Group saves its clients money that would otherwise be paid on fraudulent and abusive health claims.

Individuals who are unable to obtain insurance coverage through the open market due to a pre-existing condition or other medical reasons are generally eligible for coverage under their state high-risk pool.

"We asked The Sentinel Group to scrutinize incoming health claims to protect the resources of both insureds and the states from unscrupulous providers," said Dennis A. Call, BMI President and CEO. "Most doctors, hospitals and labs are honest, but those who aren't can financially harm the risk pool programs and our employer-based health plans if left to their own devices. We're committed to safeguarding our clients from claim fraud."

"Because people who become members of high-risk pools are sicker than most, higher claim volume and claim sizes often open up state programs to increased fraud and abuse," said Julie Malida, Sentinel Group President. "In today's market, every claims payor in the industry, particularly those involved with governmental contracts, has to guarantee that strong anti-fraud measures are in place."