It's been determined that about 25% or $900 Billion of healthcare dollars are wasted because of overtreatment, poor delivery and coordination, administrative complexity and outright fraud and abuse.  This waste affects the strength of your company and the welfare of you and your employees.  We work to identify wasteful spending and returning those funds to where they belong.  Below are some examples of waste and the value to you of identifying and fixing it.  These are real life cases that you may not be seeing for in your own plan because of lack of transparency.



Cost savings achieved through Referenced Based Pricing for Services.


Nine day hospital stay for treatment of a heart attack and pneumonia.


Billed charges: $152,189.40
RBP Allowed Charges: $38,556.26
Plan Savings: $113,633.14
Savings: 75%

Cost savings achieved through Pharmacy Management and Prescription Sourcing.


Health management Company of 128 employees and 130 members on their plan.


Name Brand & Specialty Meds: $715,203.00
Prescription Sourcing: $107,280.00
Cost Savings: $607,923.00
Plan Savings: 85%

Cost savings achieved through Medical Bill Auditing.


A 49-year-old female with acute appendicitis underwent outpatient surgery .

Billed charges: $81,467.30
Our auditing reduced: $74,665.16
Allowed: $6,802.14
Savings: 92%


A breakdown of the reduced charges were as follows:
$21,099.00 - Egregious charge for CT Scan of Abdomen/Pelvis with Contrast (Hospital's cost + 20% profit: $238.78 and Medicare allowed amount: $215.96)
$19,980.50 - Unbundled Medical Surgical Supplies (Rev Code 272)
$14,716.50 - Unbundled Surgery Charges (Rev Code 360)

Quality improvement and cost savings achieved through Comparative Effectiveness Research.

We have leveraged established and cutting edge methodologies to build our comparative effectiveness database, working with experts and researchers in the field. We take care of maintaining it, reacting to every significant trial data release and drug approval. For example, It seems implausible that a generic medication would cost more than a brand-name drug. However, that's exactly what the comparative effectiveness data makes very clear and easy to see. In one not uncommon case, the data shows that a brand will improve your health outcomes and save you up to 88% on the treatment.

Stop Loss Coverage and Premiums


Our auditing processes and multi-level methodology review both Medicare and the facility's cost of service to create a fair and reasonable payment.  This hands-on claims management provides low loss ratios and consistency for our carrier partners resulting on steady and lower rates for our clients.