Insights

As payment integrity challenges grow more complex, many health plans are moving beyond a single-vendor model and adopting a layered post-pay strategy. Vendor stacking allows organizations to combine specialized expertise, strengthen audit coverage, and improve overpayment recovery by applying multiple methodologies across the same claims environment.

Skin substitutes and biologic implants have become one of the fastest-growing cost drivers for health plans, with Medicare spending increasing more than 50-fold in six years and projected to exceed $13 billion. As utilization expands across outpatient settings, complex billing rules, percent-of-charge carve-outs, unit variability, and contract misalignment are driving hidden payment risk. This article explains how claim-level analytics, clinical validation, and contract-aware auditing help health plans identify overpayments, manage emerging risk, and maintain reimbursement accuracy as this category continues to grow.

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 Robert Haskey explains how medical audits work, why fraud, waste and abuse remain so costly, and how outdated, opaque audit models fail to prevent errors at the source.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.