Case study: Surgical Implant Cost Management

Procedure Type

Anterior posterior 360 lumbar fusion

Employer

Fortune 500 tech company

What Paradigm’s audit found

• Facility submitted pricing documents from questionable entities as manufacturer invoices
• Items implanted were found to be inconsistent with the procedure type
• Implant construct “bill of materials” violations were caught
• Disposable items (i.e., supplies) were billed as implants
• Experimental/non-reimbursable items were utilized: amniotic tissue

Total billed charges

$333,275

Paradigm recommended allowable

$50,327

Savings

$282,948 or 85%