Most employers, two-thirds, pay their own healthcare bills. They just hire insurers to do the logistics. They expect insurers to check claims to find mistakes and overpayments. But it’s not their money, and there’s no incentive to closely monitor the dollars.
That’s where so-called payment integrity companies come in. The mistakes they find are saving employers anywhere from 5% to 15% of their annual health care spend.
It’s a well-accepted fact that many medical bills have errors, and employers expect that the insurers they pay to run their health plan would catch them. Turns out that’s a bad assumption, said Joanne Hinton. She ran health benefits for the 12,000 Fort Worth employees, family members and retirees in Texas until April.
“I think we were ignorant,” Hinton said, “It’s kind of the: what you don’t know, that you don’t know.”
In 2017, Hinton found that Aetna, the city’s insurer, double-paid a $450,000 medical claim. “We were fighting them, because why did you pay this twice?” Hinton said, “That’s our money. Get it back.”
She wondered how many other mistakes Aetna was making and how much it was costing Fort Worth.
“Any dollar that we spend on healthcare is a dollar we are not spending on roads, traffic lights, firefighters, parks,” Hinton said. “It’s really important for us as a governmental entity to make sure that we are spending the money correctly.”
Aetna said in a statement that it’s committed to accurately paying claims and protecting employer dollars, citing front-end controls and retrospective reviews and recovery.
Hinton hired SmartLight Analytics. The company combs through every healthcare bill and payment to find mistakes and then gets the money back. SmartLight found about $3 million in errors, which is roughly 3% of the city’s spending on health care.
“In reality, what we’re talking about is black-and-white issues that we, for sure, can get dollars back on,” said Asha George, who co-founded SmartLight Analytics in 2015.
George used to work for insurers doing these payment checks. While the majority of claims are under $500, most carrier attention is focused on the expensive claims, she explained. That means most small-dollar claims are just auto-paid and don’t get reviewed.
“Inside a carrier, it’s a small percentage,” George said. “Almost all high-dollar claims over $20,000 will probably get some level of review.”
An insurance trade group confirmed all claims are run through automated accuracy and duplicate detection programs.
Chris Deacon ran New Jersey’s state health plan for about 800,000 people. She saw firsthand how billing errors — even small ones — can pile up. She became the whistleblower in a case against Horizon Blue Cross Blue Shield for overpaying medical claims. The insurer settled the case in 2025 and denied any wrongdoing. Now, companies turn to Deacon to make sure their health plan is actually working in their best interest.
“Your assumption is they are going to be looking out for my healthcare dollar,” Deacon said, “And I think that that assumption is completely naive and completely wrong.”
Deacon said the problem goes deeper than sloppy billing. Some insurers, she said, actually profit from fixing their own mistakes through an incentive called “shared savings,” where insurers get a cut of the dollars they overpaid.
“If we pay a million dollars, and then we figure out it should have only been 10, well, now I get to keep half of that, because I found it on the back end,” Deacon said.
Deacon often recommends hiring an independent company like SmartLight or ClaimInformatics to go through everything; they charge employers a flat fee to review claims.
“We’ve recovered tens of millions of dollars for our clients. And we’ve saved our clients tens of millions of dollars at this juncture,” Stephen Carrabba, CEO of ClaimInformatics, said. “But it’s a drop of blood in the ocean.”
The U.S. spent $5.7 trillion on healthcare last year. And it’s not just employers that are scrutinizing payments; hospitals now have so-called revenue integrity teams working the same angle. Insurers are also selling services to check their own work. Carrabba said it’s turning into a competition.
“The market is demanding third-party oversight,” Carrabba said, “because everyone has their hands in the cookie jar.”
McKinsey valued the payment integrity industry at $9 billion a few years ago and is expecting it to grow quickly as hospitals and insurers look for every dollar they can find — and employers try to keep up.