Case Histories

The argument for eligibility verification

A dependent eligibility verification remains one of the fastest and most compelling strategies to obtain immediate savings and protect your health plan from unnecessary and fraudulent claim expenditures.

We've conducted more than 475 dependent eligibility audits with more than 3.8 million dependents verified. Our results to date have produced an average ROI of 2,400 percent and an average ineligible result of nearly 7 percent.

Case Study Assumptions

Retail Company—63,000 Enrollees

Pre-Heath Care Reform   Post-Heath Care Reform
30,778 Employees Covering Dependents Subject to Audit 30,778
60,712 Dependents Subject to Audit 60,712
$2,849 Cost Per Dependent Per Year $3,133
6,627 Ineligible Dependents 5,103
1,524 Ineligible Dependents Over Age 19 0
10.92% Percentage of Dependents Found Ineligible 8.41%
$18,880,323 First-Year Savings $14,538,447
2489% First-Year Return on Investment 2061%


Health Care Organization—9,600 Enrollees

Pre-Heath Care Reform   Post-Heath Care Reform
5,572 Employees Covering Dependents Subject to Audit 5,572
11,800 Dependents Subject to Audit 11,800
$3,614 Cost Per Dependent Per Year $3,975
1,323 Ineligible Dependents 1,173
150 Ineligible Dependents Over Age 19 0
11.21% Percentage of Dependents Found Ineligible 9.94%
$4,781,322 First-Year Savings $4,239,222
2378% First-Year Return on Investment 2219%


County Government—3,814 Enrollees

Pre-Heath Care Reform   Post-Heath Care Reform
2,054 Employees Covering Dependents Subject to Audit 2,054
4,481 Dependents Subject to Audit 4,481
$3,160 Cost Per Dependent Per Year $3,476
681 Ineligible Dependents 574
107 Ineligible Dependents Over Age 19 0
15.20% Percentage of Dependents Found Ineligible 12.81%
$2,151,960 First-Year Savings $1,813,840
2734% First-Year Return on Investment 2446%