Case Study

Meticulous Second-Pass Penstock Audit Returns $4.8M to Medicare Advantage Health Insurer

Company Profile
Medicare Advantage Health Insurer

Audit Recovery
Second-Pass Audit Recovery

Post-payment, second-pass reviews (ongoing since March 2022)
In potential savings

A national Medicare health insurer was looking for a partner to conduct second-pass, post-payment audits of provider claims. Penstock was brought in after seven incumbent post-audit providers reviewed the data.


Detailed Review

Rigorous examination of coding appropriateness and payment settings based on data and medical records documentation.

Anomaly Detection

Our sophisticated algorithmic methods and decades of skilled auditor expertise highlighted payment discrepancies, spotted anomalies and discerned patterns.

Efficient Workflow

We leveraged our proprietary ClearBridge software to manage a seamless end-to-end audit workflow.

Robust Reporting

Provided in-depth, actionable reporting to help client understand their audit.

We’ve identified an additional $5.0 million in overpayments to date, achieving an overall 

Client Success

Despite seven incumbent post audit providers previously reviewing the same data, we identified $4.8M in potential savings. This led to an awarded Payment Integrity contract, covering 10 additional states!


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