Payment integrity is top of mind as insurers face growing pressure to eliminate fraud, waste and abuse. Successful programs require investment in technology and expertise to analyze trends and identify abnormalities. The team at Optum Insight works closely with insurers across the healthcare system to examine this data

In this episode of "Podnosis," Fierce Healthcare senior writer Paige Minemyer sits down with Steve Yurjevich, CEO of the payer market at Optum Insight, to discuss the challenges and solutions in this space.

To learn more about the topics in this episode: 
'Well-intentioned, poorly executed waste': How tech companies aim to reduce billions in wasteful spending
New Mountain Capital merges Apixio, Varis and The Rawlings Group in $3B deal
CMS sets up real-time medical fraud center with DOGE; Federal contractor rolls out commercial tool
Industry Voices—We need to fight fraud the right way

Payment integrity is top of mind as insurers face growing pressure to eliminate fraud, waste and abuse. Successful programs require investment in technology and expertise to analyze trends and identify abnormalities. The team at Optum Insight works closely with insurers across the healthcare system to examine this data
In this episode of "Podnosis," Fierce Healthcare senior writer Paige Minemyer sits down with Steve Yurjevich, CEO of the payer market at Optum Insight, to discuss the challenges and solutions in this space.
To learn more about the topics in this episode:&nbsp;
<ul>
<li><a href="https://www.fiercehealthcare.com/payers/how-payers-and-providers-should-think-about-payment-integrity">'Well-intentioned, poorly executed waste': How tech companies aim to reduce billions in wasteful spending</a></li>
<li><a href="https://www.fiercehealthcare.com/health-tech/new-mountain-capital-merges-apixio-varis-and-rawlings-group-3b-deal">New Mountain Capital merges Apixio, Varis and The Rawlings Group in $3B deal</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/cms-sets-real-time-medical-fraud-center-doge-federal-contractor-rolls-out-commercial-tool">CMS sets up real-time medical fraud center with DOGE; Federal contractor rolls out commercial tool</a></li>
<li><a href="https://www.fiercehealthcare.com/payer/industry-voices-we-need-to-fight-fraud-right-way">Industry Voices&mdash;We need to fight fraud the right way</a></li>
</ul>

Podnosis: the pulse of the healthcare industry. Every week, journalists from Fierce Healthcare dive into some of the industry’s biggest trends. We talk to the experts about what’s important now so you can prep for the future. Hear about all things healthcare, from physician practices to hospital chains and insurance giants—and those that mix all three—plus the tech they use, disruptors looking to compete and people moving the sector forward. Follow Podnosis on Apple Podcasts, Spotify, Amazon or wherever you get your podcasts.

Podnosis: the pulse of the healthcare industry. Every week, journalists from Fierce Healthcare dive into some of the industry’s biggest trends. We talk to the experts about what’s important now so you can prep for the future. Hear about all things healthcare, from physician practices to hospital chains and insurance giants—and those that mix all three—plus the tech they use, disruptors looking to compete and people moving the sector forward. Follow Podnosis on Apple Podcasts, Spotify, Amazon or wherever you get your podcasts.

Podnosis

Podnosis: the pulse of the healthcare industry. Every week, journalists from Fierce Healthcare dive into some of the industry’s biggest trends. We talk to the experts about what’s important now so you can prep for the future. Hear about all things healthcare, from physician practices to hospital chains and insurance giants—and those that mix all three—plus the tech they use, disruptors looking to compete and people moving the sector forward. Follow Podnosis on Apple Podcasts, Spotify, Amazon or wherever you get your podcasts.

Rethinking payment integrity 

What does the Department of Health & Human Services’ Office of Inspector General do? Today, Senior Writer Anastassia Gliadkovskaya sits down with Assistant Regional Inspector General Scott Perry to find out.

They dive into the agency’s work, the findings of a few recent audits and what providers can do to ensure they are in compliance.

The latest inpatient rehab facilities report discussed in this episode can be found here. The hospital compliance report can be found here. A general compliance guide is also available.

To learn more about the topics in this episode: 
OIG: Jury still out on impacts of vertical consolidation in Part D
More than half of patient harm events missed by hospital surveillance systems: HHS OIG
OIG: Medicare Advantage, Medicaid managed care plans often offer limited behavioral health networks

What does the Department of Health &amp; Human Services&rsquo; <a href="https://oig.hhs.gov/" aria-label="Link Office of Inspector General do">Office of Inspector General do</a>? Today, Senior Writer Anastassia Gliadkovskaya sits down with Assistant Regional Inspector General Scott Perry to find out.
They dive into the agency&rsquo;s work, the findings of a few recent audits and what providers can do to ensure they are in compliance.
The latest inpatient rehab facilities report discussed in this episode can be found <a href="https://oig.hhs.gov/reports/all/2026/unclear-medicare-requirements-led-to-differing-interpretations-of-inpatient-rehabilitation-facility-documentation-coverage-and-billing-requirements" aria-label="Link here.">here.</a> The hospital compliance report can be found <a href="https://oig.hhs.gov/reports/all/2026/sarasota-memorial-hospital-received-at-least-121-million-in-medicare-overpayments/" aria-label="Link here.">here.</a> A general compliance guide is also <a href="https://oig.hhs.gov/documents/compliance-guidance/1135/HHS-OIG-GCPG-2023.pdf" aria-label="Link available.&nbsp;">available.</a>
To learn more about the topics in this episode:&nbsp;
<ul>
<li><a href="https://www.fiercehealthcare.com/payers/oig-jury-still-out-impacts-vertical-consolidation-part-d">OIG: Jury still out on impacts of vertical consolidation in Part D</a></li>
<li><a href="https://www.fiercehealthcare.com/providers/more-half-patient-harm-events-missed-hospital-surveillance-systems-hhs-oig">More than half of patient harm events missed by hospital surveillance systems: HHS OIG</a></li>
<li><a href="https://www.fiercehealthcare.com/regulatory/oig-medicare-advantage-medicaid-managed-care-plans-often-offer-limited-behavioral-health">OIG: Medicare Advantage, Medicaid managed care plans often offer limited behavioral health networks</a></li>
</ul>

The watchdog overseeing the integrity of HHS programs  

It’s been more than two years since Eli Lilly announced LillyDirect, a platform that combines telehealth and pharmacy services to provide access to Lilly’s portfolio of diabetes, migraine and obesity medications. The goal is to offer a more transparent and affordable way to access certain drugs. The platform has quickly drawn attention from both consumers and lawmakers.

To understand LillyDirect’s growth and where it’s headed, Senior Writer Anastassia Gliadkovskaya spoke with Jen Mazur, senior vice president and general manager of U.S. LillyDirect and Consumer Services.

To learn more about the topics in this episode: 
Eli Lilly launches oral GLP-1 drug across US through Lilly Direct, telehealth providers
Lilly makes website to simplify access to obesity drug Zepbound, plus diabetes and migraine meds
'Abuse of power': Senators call out 'shady tactics' after investigating Pfizer, Lilly DTC platforms

 

It&rsquo;s been more than two years since Eli Lilly announced LillyDirect, a platform that combines telehealth and pharmacy services to provide access to Lilly&rsquo;s portfolio of diabetes, migraine and obesity medications. The goal is to offer a more transparent and affordable way to access certain drugs. The platform has quickly drawn attention from both consumers and lawmakers.
To understand LillyDirect&rsquo;s growth and where it&rsquo;s headed, Senior Writer Anastassia Gliadkovskaya spoke with Jen Mazur, senior vice president and general manager of U.S. LillyDirect and Consumer Services.
To learn more about the topics in this episode:&nbsp;
<ul>
<li><a href="https://www.fiercehealthcare.com/telehealth/eli-lillys-launches-oral-glp-1-drug-across-us-through-lilly-direct-telehealth-providers">Eli Lilly launches oral GLP-1 drug across US through Lilly Direct, telehealth providers</a></li>
<li><a href="https://www.fiercepharma.com/marketing/lilly-makes-website-simplify-access-obesity-drug-zepbound-plus-diabetes-and-migraine-meds">Lilly makes website to simplify access to obesity drug Zepbound, plus diabetes and migraine meds</a></li>
<li><a href="https://www.fiercepharma.com/marketing/senators-condemn-big-pharmas-shady-tactics-after-investigating-pfizer-lilly-dtc-platforms">'Abuse of power': Senators call out 'shady tactics' after investigating Pfizer, Lilly DTC platforms</a></li>
</ul>
&nbsp;

An insider’s look at LillyDirect

Is AI in health care overhyped — or underutilized? In this sponsored episode of Podnosis, host Irena speaks with Sanjay Subramanian, SVP & Head of Healthcare Payer Business at Cognizant at Cognizant, about where artificial intelligence is delivering measurable ROI today and why many organizations struggle to scale adoption.

Sanjay explains that back‑office functions such as claims processing, prior authorization and revenue cycle management are seeing the strongest results, thanks to data‑rich workflows and clear operational metrics. He also outlines why more complex use cases, including autonomous clinical decision‑making, remain constrained by fragmented data, regulatory requirements and trust challenges.

The discussion explores common mistakes leaders make when funding AI initiatives, including chasing disconnected use cases, underestimating data readiness and focusing on pilots instead of enterprise outcomes. Looking ahead, Sanjay describes how connected intelligence, responsible AI governance and human‑in‑the‑loop models will shape the next phase of health care transformation — and why AI’s future lies in augmenting decision‑making, not replacing it.

 

Guest Bio

Sanjay Subramanian is a transformational leader with over 29 years of expertise in profit and loss management, sales and delivery across management consulting, systems integration and outsourcing. He is recognized for guiding CXO clients through strategic business decisions and digital transformation, consistently delivering measurable outcomes in challenging environments. Sanjay has led successful turnarounds, managed large teams exceeding 5000 members and originated transformative outsourcing contracts totaling over $8 billion with Fortune 100 clients. His experience spans Asia Pacific, the UK and North America, across industries including healthcare, life sciences, automotive, manufacturing, retail, energy, utilities, transportation and logistics. He has built and scaled businesses, launched new consulting capabilities and enabled cross-functional collaboration among diverse stakeholders. Sanjay brings a strong focus on client relationships and long-term value creation, supporting sustained growth across major global accounts.

Is AI in health care overhyped &mdash; or underutilized? In this sponsored episode of Podnosis, host Irena speaks with Sanjay Subramanian, SVP &amp; Head of Healthcare Payer Business at Cognizant at Cognizant, about where artificial intelligence is delivering measurable ROI today and why many organizations struggle to scale adoption.
Sanjay explains that back‑office functions such as claims processing, prior authorization and revenue cycle management are seeing the strongest results, thanks to data‑rich workflows and clear operational metrics. He also outlines why more complex use cases, including autonomous clinical decision‑making, remain constrained by fragmented data, regulatory requirements and trust challenges.
The discussion explores common mistakes leaders make when funding AI initiatives, including chasing disconnected use cases, underestimating data readiness and focusing on pilots instead of enterprise outcomes. Looking ahead, Sanjay describes how connected intelligence, responsible AI governance and human‑in‑the‑loop models will shape the next phase of health care transformation &mdash; and why AI&rsquo;s future lies in augmenting decision‑making, not replacing it.
&nbsp;
Guest Bio
Sanjay Subramanian is a transformational leader with over 29 years of expertise in profit and loss management, sales and delivery across management consulting, systems integration and outsourcing. He is recognized for guiding CXO clients through strategic business decisions and digital transformation, consistently delivering measurable outcomes in challenging environments. Sanjay has led successful turnarounds, managed large teams exceeding 5000 members and originated transformative outsourcing contracts totaling over $8 billion with Fortune 100 clients. His experience spans Asia Pacific, the UK and North America, across industries including healthcare, life sciences, automotive, manufacturing, retail, energy, utilities, transportation and logistics. He has built and scaled businesses, launched new consulting capabilities and enabled cross-functional collaboration among diverse stakeholders. Sanjay brings a strong focus on client relationships and long-term value creation, supporting sustained growth across major global accounts.

Rethinking payment integrity

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