How Payment Integrity Firms Are Saving Billions in Healthcare

Episode 13 of Services Economy with Fexingo dives into the booming industry of payment integrity — the software and services that audit healthcare claims for overpayments, fraud, and coding errors. Lucas and Luna explore how companies like Cotiviti and HMS (now Gainwell Technologies) have built billion-dollar businesses by helping insurers and employers recover wasted dollars. They break down the specific numbers: how a single overpayment for a 'comprehensive metabolic panel' can cost $500, and why the industry now saves roughly $3 for every $1 it spends. The hosts also discuss the tension between legitimate cost recovery and aggressive audits that burden providers. If you've ever wondered why a simple doctor visit generates a baffling bill, this episode traces part of the problem back to the payment integrity industry — and why it's growing at 15% annually. #PaymentIntegrity #HealthcareCosts #Cotiviti #GainwellTechnologies #MedicalBilling #FraudDetection #Overpayments #ClaimsAudits #HealthInsurance #RevenueCycleManagement #ServicesEconomy #BusinessPodcast #FexingoBusiness #HealthcareFinance #Economics #CostContainment #DataAnalytics #HealthPolicy Keep every episode free: buymeacoffee.com/fexingo