Why Eight Patients Can End Up in Federal Court

The post: Brad pointed to five hospitals suing an insurer in federal court over claims for just eight patients, about $345,000 in dispute. His point: a huge administrative machine now surrounds one basic transaction, and AI is being added to both sides of it.

Read Brad Justus's original post on LinkedIn →

My comment:

I spent a decade on the inside of this system, at the center of one of the largest fraud cases in it. So I'll offer the uncomfortable version of what this thread is circling: the administrative arms race isn't a bug, it's the business model. Every dollar spent on denial, appeal, review, and litigation is a dollar the system has quietly decided is cheaper than fixing the transaction underneath it. I know, because I built a company that lived in exactly those gaps. The reason eight patients can generate a federal lawsuit is that the system makes fighting more profitable than getting it right the first time — for everyone except the patient and the taxpayer. Adding AI to both sides doesn't fix that. It just makes the fight faster and more expensive. The real question isn't who wins this suit. It's why we've built a $5 trillion system where this is a rational outcome.

Originally posted as a comment on LinkedIn.