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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