Selling Your FBO Starts With Preparation
Selling an aviation business rarely begins with simply finding a buyer. The outcome is usually shaped long before the first buyer conversation—through valuation, documentation, and a disciplined process that positions the business correctly in the aviation market.
FBOsForSale works with aviation business owners nationwide who are considering how to sell my FBO through a confidential transaction process designed to attract qualified buyers and maintain leverage throughout negotiations.
innovate. Educate. Elevate
Your Claims Data Already Contains the Overpayments. The Audit Finds Them.
Healthcare is your second-largest expense after payroll. Every other cost center at your company is governed with data, accountability, and vendor discipline. Your health plan should be no different.
Fiduciary Focused
Your Interest. Our Priority.
Transparent Economics
Clarity in costs. Confidence in decisions
Vendor Accountability
Aligned incentives.
Stronger outcomes.
Data-Driven Strategy
Smarter insights. Better results.
MEasurable Results
Proven impact. Sustainable savings
A Better Way Forward
Legacy insurance companies, legacy brokerages, and their vendor ecosystems were built for a different era - with different incentives. FiduciaHealth™ was built for today and tomorrow. We empower employers with the governance, transparency, and strategy needed to control costs, eliminate waste, and improve healthcare outcomes - without compromising employee benefits.
20-40%
Typical Total Cost Savings Identified
20-40%
Typical Total Cost Savings Identified
20-40%
Typical Total Cost Savings Identified
Fiduciary Oversight. Transparent Solutions. Measurable Results.
Billing irregularities — upcoding, unbundling, duplicate charges, medically unnecessary services — are not edge cases in employer health plans. They are systematic patterns that accumulate silently inside every plan that lacks independent audit oversight.
Four Billing Irregularities Costing Your Plan Money Right Now
Most employers have never seen these defined. Most carriers have no financial incentive to find them.
Upcoding — a provider bills for a higher-intensity service than was actually delivered. A standard office visit billed as a complex evaluation. A routine surgical procedure coded at a higher complexity tier. The charge is paid automatically by the carrier or TPA unless a clinical audit flags it. Under carrier adjudication, it rarely is.
Unbundling — component procedures that are meant to be billed as a single bundled service are instead billed as individual line items, each carrying its own charge. The total billing exceeds what the bundled code would have produced. The overpayment is invisible unless the claim is reviewed at the line-item level.
Duplicate billing — the same claim submitted more than once through different coding pathways, different provider tax IDs, or different date-of-service entries. Automated adjudication systems catch exact duplicates. Near-duplicates with minor variation routinely pass through.
Medically unnecessary services — services billed under a diagnosis code that does not meet clinical appropriateness criteria for the procedure performed. The claim is technically complete. The clinical justification does not hold under independent review.
Two examples from Scott's billing audit work illustrate the scale: a knee replacement billed at approximately $58,000 was re-adjudicated to approximately $25,000 — roughly $33,000 recovered on a single claim. A hernia repair billed at approximately $60,000 should have been approximately $7,000 — roughly $53,000 in overpayment on one procedure.
The Federal Investigation Context Your Carrier Hasn't Mentioned
UnitedHealth Group, Cigna, Anthem, and Humana have been under active Department of Justice investigation or litigation for upcoding, phantom billing, and related billing irregularities in their Medicare Advantage programs since last year. Some have settled. These are not isolated incidents. They are documented patterns in the billing systems and coding practices these carriers operate at scale.
The same internal billing systems used in Medicare Advantage are used in commercial employer plans. Fully insured employers have no audit rights under standard carrier contracts — which means these patterns cannot be detected, challenged, or recovered under a legacy arrangement. The carrier adjudicates the claim, retains the administrative fee, and the overpayment remains in place. After the carrier settles with the government, nothing changes with Private employer contracts. Employers are 100% on their own with no avenues to recover or stop overcharging in their plans. Fully insured plans generally do not have any rights to audit their claims.
Self-funded plans structured under Scott's Advanced Benefit Design
FudicuaHealth Governance framework include full employer audit rights as a core feature — not a negotiated add-on.
Past Overpayments Are Recoverable — Including Under Prior Plan Years
Employers transitioning from fully insured to self-funded arrangements frequently carry years of prior billing irregularities that occurred under carrier adjudication. Because the carrier controlled the audit rights, those overpayments were never identified or challenged.
The Cost Modeling Report identifies whether historical overpayment recovery is viable in the employer's specific situation before any audit engagement begins.
How Claims Re-Adjudication Works — and Why Your Employees Never Notice
Claims re-adjudication is the process of reprocessing all paid claims for the purpose of comparing adjudication services and network discounts. It is a function we perform to compare procedure cost differences existing between networks — not a provider negotiation or a hospital confrontation.
Employee access to care and provider network relationships are unaffected throughout the process.
Scott coordinates the re-adjudication process through our independent TPA relationship, using the employer's audit rights to access the claims data, identify the irregularities, claim by claim, against the specific billing patterns the repricing surfaces.
Frequently Asked Questions
How do I audit hospital bills for our employer health plan?
Auditing hospital and facility claims requires two things: audit rights over your plan's claims data, and an independent reviewer with the clinical and coding expertise to identify irregularities at the line-item level. Fully insured employers typically have neither under standard carrier contracts. Self-funded plans with independent TPA administration include both. Scott's engagement begins with the Cost Modeling Report, which identifies anomalous billing patterns in the employer's actual claims data before any formal audit engagement is scoped.
What is upcoding in an employer health plan?
Upcoding is when a provider bills for a higher-complexity or higher-intensity service than was actually delivered — a routine procedure coded at a tier that carries a substantially higher reimbursement rate. It passes through automated adjudication systems without clinical review. Independent billing audit identifies it by comparing the diagnosis code, procedure code, and clinical documentation against the appropriate coding standard.
Can we recover healthcare overpayments from prior plan years?
In many cases, yes. Overpayments that occurred under prior carrier adjudication can be reviewed and pursued for recovery under the applicable statute of limitations once the employer has established audit rights through a self-funded plan structure. The Cost Modeling Report identifies whether historical recovery is viable in the employer's situation.
Will a billing audit disrupt our provider relationships or employee care?
No. Claims re-adjudication is conducted through the TPA and plan administrator using established appeals channels. The employer does not negotiate with hospitals or contact providers directly. Employee access to care is unaffected. The process is administrative and financial — providers are addressed through the plan's formal dispute resolution process, not through the employer's operational relationships.
What is the difference between a healthcare billing audit and claims re-adjudication?
A billing audit identifies the irregularities — upcoding, unbundling, duplicate billing, medically unnecessary services — by reviewing claims data against clinical and coding standards. Claims re-adjudication is the recovery process: reprocessing the improperly paid claims under correct coding and pursuing repayment through formal appeals channels. Scott conducts both as part of an integrated engagement, coordinated through the independent TPA.
