About eighty cents of every hundred dollars in American medical claims is fine. The other twenty is where TJ Ademiluyi lives. He runs Alaffia Health, a New York company that reviews medical claims for health plans, and his pitch is unglamorous in the way that large numbers usually are: roughly 80% of US medical claims carry at least one error, and something like $300 billion a year leaks out of the system as waste and fraud. Most of it, he is careful to say, is not villainy. It is human error, opaque processing, and incentives that point in slightly different directions.
Alaffia's product is a piece of software that does what a very patient auditor would do if the auditor never slept: it extracts the clinical facts out of a medical record, lines those facts up against what the provider billed, and checks the whole thing against reimbursement policy and clinical guidelines. When the bill and the record disagree, it flags the gap before the money moves. The company says it hits 97% accuracy pulling those facts out of messy documentation, saves an average of more than 20% on high-cost facility claims, and has returned over $100 million to its customers since launch.
What makes the story worth telling is not the dashboard. It is that Ademiluyi did not stumble into healthcare billing. He was raised next to it.