Know where your health plan is overpaying.
Vlada audits self-insured health plans against curated transparency data. Every finding links to a source file, a peer benchmark, and a remediation path.
American self-insured employers spend $1.1T a year on healthcare. They cannot tell you where most of it goes.
67% of US covered workers are on self-insured employer health plans. Those plans cover 103 million Americans. Per-employee spending is projected to exceed $18,500 in 2026 — a 62% increase since 2017. Yet most employer plan sponsors cannot produce, on demand, a defensible account of what they paid for a given procedure, at a given provider, versus what peer plans paid.
22% of ERISA class actions in 2025 targeted health plans. The plaintiffs’ bar has a new target.
In February 2024, Cohen Milstein and Fairmark Partners filed Lewandowski v. Johnson & Johnson — the first major ERISA fiduciary-breach class action targeting a self-insured employer’s health plan. The complaint alleged J&J’s benefits committee failed to prudently monitor PBM drug pricing, citing a 498% markup on a generic MS medication.
The case was dismissed on Article III standing grounds and is on appeal to the Third Circuit. But in March 2026, Stern v. JPMorgan Chase partially survived a motion to dismiss on the merits — the first PBM-ERISA case to do so. Hecht v. Cigna settled for $6M in October 2025. Schlichter Bogard named Mercer, Gallagher, WTW, and Lockton as co-defendants in a December 2025 voluntary-benefits quartet. Consultants are now in the blast radius.
“The duty of prudence under ERISA § 404(a)(1)(B) requires plan fiduciaries to act with the care, skill, prudence, and diligence of an expert in the field.”
Fisher Phillips, “10 Best Practices for ERISA Health Plan Fiduciary Obligations,” Feb 2024
The federal government compelled every insurer in America to publish negotiated rates. Then they published garbage.
of 3.1 billion negotiated rates published by US insurers are ghost rates — services providers virtually never perform.
The Transparency in Coverage Rule (2022) requires every commercial payer to publish negotiated rates for every in-network provider and service. On paper, this is the largest public healthcare pricing dataset ever assembled.
In practice, the median insurer’s file is 84% unusable. At the provider-code level, 95.4% of published rates are for services that provider almost certainly never performs — a dermatologist quoted for cardiac bypass, a podiatrist quoted for neurosurgery.
Benchmarking an employer’s actual paid claims against raw transparency data produces statistical noise, not evidence. Every serious use of this data begins with curation.
An AI agent that audits your health plan the way an ERISA attorney would — continuously, with evidence.
Connect your claims
Secure upload or a read-only TPA connection. Vlada audits against the largest curated pricing dataset in the US — ghost-filtered, entity-resolved, refreshed monthly.
Find the overpayments
Every paid claim is cross-referenced against peer-plan benchmarks, Medicare rates, and transparent-PBM comparators. Findings carry dollar impact, provider name, citation lineage, and severity.
Plan the remediation
TPA re-negotiation playbooks. RFP templates. Plan-design change models. Continuous monitoring proves whether the savings materialized.
Across 2,404 paid claims in Q1 2026, Vlada identified $3.1M in estimated overpayment concentrated in three categories:
Every finding carries source lineage back to the relevant TiC MRF and peer-plan benchmark. Would you like to drill into one, or export a board-ready summary?
Every Vlada finding is designed to hold up under cross-examination.
If a plaintiff’s or defense attorney cannot reconstruct a Vlada finding from its lineage — from raw source file to benchmark to dollar impact — the finding isn’t defensible. We don’t surface it.
Source file hash
Row-level lineage
Freshness metadata
Peer distribution sample
Vlada serves the people with a legal, professional, or technical need for defensible healthcare pricing evidence.
Audit one plan.
CFOs, General Counsel, Heads of Total Rewards at self-insured employers. Fulfill your fiduciary duty with evidence.
Deploy Vlada to your book.
Differentiate your advisory posture. Add a new tech-enabled revenue stream. Protect your own fiduciary exposure in the post-Schlichter Bogard environment.
Review the methodology.
Plaintiff-side and defense ERISA attorneys. Review Vlada's evidence pipeline against your discovery and admissibility standards.
Add Vlada to your agent.
Healthcare AI developers building RCM, prior-auth, navigation, or audit products. MCP server, REST API, source-cited responses.
The output is a document your board can read and your counsel can defend.
- Renegotiate DRG 470 bundle at Facility Y
- RFP competing TPA for outpatient imaging
- Evaluate transparent PBM for specialty infusion
Every healthcare AI agent should speak fluent negotiated rates.
Vlada ships an MCP server and a productized REST API. Add vlada-pricing to your agent and your product can cite healthcare pricing with source lineage, ghost-rate filtering, and entity resolution across the hospital–commercial payer boundary.
Registered in Anthropic’s MCP directory, published on Smithery, PulseMCP, and Glama. OAuth 2.1, usage-metered pricing, full OpenAPI spec.
# Install in Claude Desktop, Cursor, or any MCP-native agent:
$ npx @vladahealth/mcp-install
# Or call the REST API directly:
$ curl https://api.vladahealth.com/v1/rates \
-H "Authorization: Bearer $VLADA_API_KEY" \
-d '{"npi": "1234567890", "code": "99213", "payer": "aetna"}'| Tool | Purpose | Returns |
|---|---|---|
| get_negotiated_rate | Rate for NPI × code × payer | Rate + source lineage |
| compare_rates | Distribution for code in geography | Percentile distribution |
| find_overpayment | Paid claim vs. peer benchmark | Finding + remediation |
| list_providers | Specialty × geography filter | Provider list |
| get_benchmark | Code benchmark by state / MSA | Distribution summary |
| get_hospital_chargemaster | Hospital chargemaster lookup | Full chargemaster |
One plan. One audit. One report you can show your board.
Vlada audits a single plan as a design-partner engagement. The output is a defensible audit report, delivered to you and your counsel, with no obligation beyond the review call.