Quantify Health

Fraud Waste & Abuse

Quantify Health lowers the cost of healthcare for health plans (commercial, Medicare, Medicaid, Individual, etc.) through forensic claim audit services. We deliver average savings of over $150 per member per year in a shared savings model where the health plan keeps 70% of the savings we deliver, and we get 30% – no other costs involved. How it works: High cost claims (hospital claims over $100,000) and medical implants are major categories of healthcare spend, and there is significant overcharging happening by providers. Our proprietary methodology identifies the overcharging and works with the health plan to lower the amount on a pre-payment basis.

Three elements that differentiate us:
• Forensic review by physicians: Our forensic review that takes tens of hours is done by nurse practitioners and physicians with expertise in specific areas such as oncology, neonatal, transplants, etc. and we perform a deep-dive on itemized charges and medical records.
• In-depth supporting evidence: Our physicians and nurse practitioners then develop an extremely detailed 10-30 page report with all the evidence and medical background to prove all the savings. This has the impact of minimizing any potential pushback from the hospitals.
• Proactive reach outs: Once the claim is paid by the payer at the lower, correct amount, our team will proactively reach out to the hospital and share this detailed report and address any pushback or appeals without involving the health plan.

Raj Sandhu


3 Columbus Circle, 15th Floor
New York, NY 10019