Insights

Medical coding errors and flawed audit systems quietly add a “hidden tax” to healthcare—driving higher premiums, increased out-of-pocket costs, and strained provider reimbursements. In this insight, Dr. Robert Haskey explains how medical audits work, why fraud, waste and abuse remain so costly, and how outdated, opaque audit models fail to prevent errors at the source. He outlines a better path forward: deeper, clinically grounded audits that focus on root-cause prevention, provider education, and smarter use of human expertise and technology to make payment accuracy a shared responsibility across the healthcare system.

Steve Palma, President & General Manager of Penstock, has spent more than 25 years challenging the traditional payment integrity model. From rebuilding Oxford Health Plans' investigative and claims operations in the 1990s to reshaping how modern PI vendors address systemic overpayments, his mission has remained the same: fix what’s broken in the healthcare payment system. This spotlight explores Steve’s career journey, the industry-wide flaws he is working to correct, and how Penstock is championing a transparent, prevention-first approach supported by human expertise and emerging AI technology.

A stagnant payment integrity program can quietly erode accuracy, increase abrasion, and leave major recoveries undiscovered. This insight outlines the hidden warning signs—rising provider friction, growing manual workload, and vendors who only catch low-value issues—and explains what a high-attention, auditor-led PI partner should deliver to help plans recover more, improve processes, and reduce long-term leakage.

Vendor consolidation in the payment integrity market is reshaping how service, innovation, and attention are delivered—often to the detriment of state and regional health plans. This insight outlines the hidden costs of being deprioritized by a large PI vendor, the warning signs that your post-payment audit partner isn’t giving you the attention you deserve, and strategies regional plans can use to regain transparency, accountability, and performance in a shifting PI landscape.

Penstock is using AI and machine learning to accelerate how new payment integrity concepts are discovered, validated, and deployed. In this Q&A;, President Steve Palma explains how AI identifies subtle trends in claims data, detects nuanced anomalies, enhances concept precision, and strengthens prevention strategies. Learn how Penstock blends AI-driven analysis with human clinical expertise—and why agentic AI is opening new possibilities for data quality, audit support, and end-to-end payment accuracy.

Selecting the right payment integrity partner isn’t about choosing the biggest firm or the lowest price—it’s about finding balance. This insight explains why large PI vendors can fall short on flexibility, personalization, and transparency, and why emerging and mid-size partners often deliver the agility, innovation, and hands-on support health plans need. You’ll learn the key criteria for evaluating a PI partner and how to identify a solution that’s “just right” for your organization.