$7.4 Million Found in 60 Days: How AI Is Exposing Hidden Claims Waste | Broken Healthcare #93

Your healthcare claims have an error rate of 8 to 12%. Most employers have no idea.In this episode of Broken Healthcare, Ray Kober sits down with Stephen Carrabba - CEO and Co-Founder of Claim Informatics - to break down what's really happening behind the scenes in healthcare claims, payment integrity, and fiduciary oversight.Stephen's team recently found $7.4 million in improperly paid claims for a single client. In two months. At a 10.9% error rate.And the fix isn't complicated. It just requires someone with no conflicts of interest to actually look.In this episode:→ Why 8-12% of healthcare claims are paid incorrectly→ The "sub $15,000" TPA story that should make every CFO furious→ Why the shared savings model creates perverse incentives and what Claim Informatics does differently→ How AI is being used to analyze 15,000 pages of contracts and find violations hiding in plain sight→ Why combining two clauses on page 1 and page 111 of your ASO can legally authorize spread pricing — and nobody catches it→ The fiduciary exposure every plan sponsor is carrying right now→ Why post-payment recovery gets harder over time and why prepayment is the smarter play→ What Marilyn Bartlett found when Montana finally just asked some simple questions ($113 million, as it turns out)→ Why "garbage in, garbage out" applies to AI - and why building a real system took 8 monthsIf you're an employer, CFO, HR leader, broker, TPA, or benefits consultant.. this episode will change how you think about every claim your plan has ever paid.🔗 Claim Informatics: claiminformatics.com📊 Independent assessment for employers: benefixa.com/#consult🎙️ Subscribe to Broken Healthcare: youtube.com/@BrokenHealthcarePodcastTimestamps:0:00 Why Healthcare Claims Feel Broken2:12 How Stephen Got Into the Space5:10 From Pharma Audits to Claim Informatics8:20 Why Medical Claims Are More Complex11:35 The Broker and TPA Problem14:20 What Changed After the CAA17:10 Why Data Access Matters20:20 How Claims Are Audited23:35 Prepayment vs Post-Payment27:00 Real Savings at Scale30:15 How Their Fee Model Works33:20 Why Shared Savings Creates Conflicts36:40 Independent Oversight and Fiduciary Risk40:05 Why Recovery Gets Harder Over Time43:10 How Much Money Gets Missed46:20 Why Contracts Matter49:30 The AI Layer53:05 What Employers Should Demand57:00 Final Thoughts#BrokenHealthcare #HealthcareClaims #ClaimInformatics #StephenCarrabba #PaymentIntegrity #ERISA #CAA #FiduciaryDuty #HealthcareTransparency #AIinHealthcare #EmployerBenefits #HealthcareCosts #TPA #SelfFundedHealthcare #Podcast Hosted on Acast. See acast.com/privacy for more information.