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
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