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

$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 months If 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/@BrokenHealthcarePodcast Timestamps: 0:00 Why Healthcare Claims Feel Broken 2:12 How Stephen Got Into the Space 5:10 From Pharma Audits to Claim Informatics 8:20 Why Medical Claims Are More Complex 11:35 The Broker and TPA Problem 14:20 What Changed After the CAA 17:10 Why Data Access Matters 20:20 How Claims Are Audited 23:35 Prepayment vs Post-Payment 27:00 Real Savings at Scale 30:15 How Their Fee Model Works 33:20 Why Shared Savings Creates Conflicts 36:40 Independent Oversight and Fiduciary Risk 40:05 Why Recovery Gets Harder Over Time 43:10 How Much Money Gets Missed 46:20 Why Contracts Matter 49:30 The AI Layer 53:05 What Employers Should Demand 57:00 Final Thoughts #BrokenHealthcare #HealthcareClaims #ClaimInformatics #StephenCarrabba #PaymentIntegrity #ERISA #CAA #FiduciaryDuty #HealthcareTransparency #AIinHealthcare #EmployerBenefits #HealthcareCosts #TPA #SelfFundedHealthcare #Podcast ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

From The Convent to The White House to Fixing Broken U.S. Healthcare | Broken Healthcare Podcast #92

Katy Talento joins the show in-studio to share her unique journey from religious life to advising on healthcare policy at the highest levels of government - and what she believes it will take to fix the U.S. healthcare system. With a background in epidemiology, public health, and federal policy, Katy brings rare insight shaped by her experience working in the U.S. Senate and advising on healthcare issues at the White House. Her career spans global public health work, infectious disease research, and shaping national healthcare policy that impacts employers, patients, and the broader healthcare system. In this conversation, Katy shares how her early desire to change the world led her into public health, policy, and ultimately into healthcare reform efforts in Washington. She explains how incentives inside the healthcare system influence decision-making, why meaningful reform can be difficult to achieve, and why healthcare costs continue to rise despite ongoing policy changes. We also discuss how employer-sponsored healthcare plays a central role in the U.S. system, why prevention-focused models such as Direct Primary Care (DPC) are gaining attention, and how transparency may help improve healthcare outcomes over time. Subscribe for more conversations focused on improving healthcare outcomes and fixing the broken healthcare system. #HealthcareReform #HealthPolicy #HealthcareCosts #DirectPrimaryCare #EmployerHealthcare #HealthcareInnovation #HealthcareLeadership #HealthInsurance #PublicHealth #HealthcareTransparency 00:00 Intro 00:23 Welcome Katy Talento 01:30 Early life and desire to change the world 04:30 Faith journey and decision to enter religious life 08:00 Global public health work and infectious disease research 12:30 Working internationally in public health 16:00 Entering Washington health policy 20:00 Writing healthcare legislation in the U.S. Senate 24:00 How healthcare policy is shaped in Washington 29:00 Speechwriting and political communications 32:30 Industry influence in healthcare policy 36:00 Why healthcare reform is difficult to achieve 40:00 How incentives influence healthcare decisions 45:00 Employer-sponsored healthcare and system complexity 52:00 Insurance incentives and unintended consequences 58:00 Why healthcare costs continue to rise 1:05:00 Transparency and accountability in healthcare 1:12:00 Direct Primary Care and prevention-focused models 1:18:00 Where meaningful reform may come from 1:25:00 The future of healthcare policy 1:31:00 Final thoughts on fixing U.S. healthcare ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Broken Healthcare Costs, Self-Funding, Anti-BUCA & Real Reform | Broken Healthcare Podcast #91

Emma Fox joins the show in-studio to explain why healthcare costs keep rising and how incentives inside the traditional health insurance system often work against employers and patients. Drawing on her experience inside the industry, Emma breaks down how compensation structures, carrier incentives, and consolidation influence employer-sponsored healthcare decisions. She explains why more organizations are exploring self-funded health plans, independent TPAs, direct primary care, and reference-based pricing as alternatives to traditional insurance models. We also discuss how collaboration between employers, advisors, and physicians can help create more transparent healthcare strategies, and why education initiatives like Symposium are helping drive innovation across the healthcare ecosystem. If you are an employer, advisor, HR leader, or healthcare professional trying to better understand rising healthcare costs, this conversation offers practical insight into how the system works and where change may happen. Subscribe for more conversations focused on improving healthcare outcomes. #HealthcareCosts #SelfFundedHealthPlans #HealthInsurance #EmployerBenefits #HealthcareInnovation #HealthcareTransparency #DirectPrimaryCare #ReferenceBasedPricing #BenefitsStrategy #HealthcareReform #TPA #HealthcareEconomics #HealthcareLeadership #BUCAIncentives 00:00 Intro 01:10 Emma’s journey from the UK to U.S. healthcare 03:00 Starting in life insurance and entering the insurance industry 08:30 Understanding health insurance incentives 12:00 Ethical conflicts inside traditional insurance models 15:00 Advisor compensation structures and industry challenges 18:00 Capitalism and healthcare economics 21:00 Government influence and healthcare policy realities 23:00 The employer’s role in fixing healthcare 27:00 The origin of Symposium 30:00 Bringing employers, advisors, vendors, and physicians together 32:00 Why physicians must be part of the healthcare conversation 35:00 Private equity and healthcare delivery challenges 38:00 Collaboration between doctors and advisors 42:00 Purpose-driven advisory models 45:00 Vision for improving the healthcare system 52:00 Advice for employers evaluating healthcare strategies 58:00 Industry collaboration and future outlook 1:04:20 How to connect with Emma Fox ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Functional Medicine, Longevity & Why Doctors Are Leaving The System | Broken Healthcare Podcast #90

Tim Organ, CEO of the Health Business Growth Collective, joins the show in-studio to discuss why the traditional healthcare system focuses on symptoms instead of root cause - and how functional medicine is changing the future of patient care. Tim shares his personal health transformation, including reducing body fat, optimising metabolic health, increasing protein intake, and improving longevity through lifestyle changes. He explains how functional medicine identifies underlying causes of illness, why regenerative therapies may reduce the need for surgery, and how practitioners are building independent health businesses outside the insurance model. We also explore AI-driven healthcare tools, preventative testing, and why the future of medicine may be more personalised, data-driven, and focused on long-term health outcomes. 📌 Subscribe for more conversations on fixing the broken healthcare system. #FunctionalMedicine #Longevity #RootCause #MetabolicHealth #PreventativeHealth #RegenerativeMedicine #HealthcareInnovation #Biohacking #HealthOptimization #FutureOfHealthcare #Wellness #AIHealthcare 01:00 Tim Organ & Health Business Growth Collective 04:20 Personal health transformation & body composition changes 07:00 Protein intake, diet tracking & metabolic health 10:00 Lifestyle habits & fitness discipline 13:30 Longevity fundamentals: exercise, diet & sleep 16:30 Functional medicine vs symptom-based healthcare 20:00 Finding the root cause of chronic illness 23:00 Tim’s healthcare career journey 27:00 Digital healthcare systems & medical technology 29:30 Why practitioners are leaving insurance-based models 33:00 Challenges doctors face inside traditional healthcare 36:00 Regenerative medicine vs surgery 41:00 Why many orthopaedic procedures may be avoidable 45:00 AI in healthcare & interpreting lab data 48:30 Expanding access to functional medicine 51:00 Food systems, nutrition & chronic disease 54:00 Personal responsibility & preventative health 57:00 The future of personalised medicine 1:02:00 Business models for modern practitioners 1:07:00 Technology & data-driven health insights 1:12:00 Longevity mindset & maintaining muscle as we age 1:17:00 Final thoughts on fixing broken healthcare ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Healthcare Is Breaking — Here’s How Angle Health Plans to Fix It | Broken Healthcare Podcast #89

David Slepak & Caleb Parker (Angle Health) on fixing the broken U.S. healthcare system. Why do healthcare costs keep rising? Why do employers feel stuck? And what would it actually take to fix the experience? In this episode of Broken Healthcare, we break down what’s really driving costs, what most plans get wrong, and how smarter design + technology could reshape employer healthcare. #BrokenHealthcare #AngleHealth #HealthInsurance #EmployerBenefits #HealthcareCosts #HealthcareInnovation #AIinHealthcare #Podcast #BenefitsConsulting #HealthcareLeadership 0:00 Why Healthcare Feels Broken 1:02 From State Farm to Fixing Healthcare 5:02 What Makes Angle Health Different 7:02 Bad Benefits vs Bad Experiences 11:00 The Tech + AI Advantage 16:00 Why Speed Wins in Healthcare 21:00 Palantir Roots & Data Strategy 24:30 Why Costs Keep Exploding 30:00 The Insurance Card Problem 34:30 Fixing Friction in Healthcare 40:00 Guiding Patients to Better Care 44:00 Why Legacy Carriers Struggle 49:00 Incentives That Actually Work 57:00 The Truth About Pharmacy Spend 59:30 Final Thoughts ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.