MSP Recovery is a healthcare reimbursement recovery and data analytics company focused on discovering and recovering improper payments for Medicare, Medicaid, and commercial health insurers. The company uses proprietary algorithms and data analytics to identify recoverable Claims from historical medical data, targeting gaps between billed and paid amounts. Its core mission involves pursuing recoveries through statutory and case law foundations, particularly under the…
MSP Recovery is a healthcare reimbursement recovery and data analytics company focused on discovering and recovering improper payments for Medicare, Medicaid, and commercial health insurers. The company uses proprietary algorithms and data analytics to identify recoverable Claims from historical medical data, targeting gaps between billed and paid amounts. Its core mission involves pursuing recoveries through statutory and case law foundations, particularly under the Medicare Secondary Payer Act.
MSP Recovery generates revenue primarily through its recovery business model, wherein it receives irrevocable assignments of Claims recovery rights from Assignors such as MAOs, MSOs, HMOs, hospitals, and other at-risk entities. Under these Claims Cost Recovery Agreements (CCRAs), the company typically retains 50% of net recoveries after paying 50% to the Assignor, though in some cases it purchases recovery rights outright to retain 100% of proceeds. Revenue is tied to successful litigation or settlement outcomes, not to service fees, and the company did not recognize any Claims recovery service income during the year ended December 31, 2024.
The company operates through the following segments:
- Claims Recovery: This segment focuses on identifying and pursuing recoverable Claims through statutory frameworks like the MSP Act, utilizing proprietary data analytics to detect waste, fraud, and abuse in Medicare, Medicaid, and commercial health insurance sectors. The company employs its internal team of data scientists and medical professionals to analyze historical Claims data and validate potential recovery paths. Once validated, Claims are pursued through litigation with contracted law firms, where MSP Recovery acts as plaintiff due to its assigned recovery rights.
- Chase to Pay: This segment provides a near real-time analytics-driven platform designed to identify the proper primary insurer at or near the point of care to prevent wrongful payments. The platform integrates with medical utilization platforms used by providers during patient care and treatment, aiming to improve payment accuracy and reduce legal recovery costs. MSP Recovery intends to monetize this platform as a standalone product in the future, although it has not yet generated significant revenue from it.
- MSP/Palantir Clearinghouse Platform: This segment involves a collaboration with Palantir to develop a clearinghouse platform that identifies, quantifies, and resolves outstanding liens using AI, NLP, and ML technologies. The platform enhances data connectivity between property and casualty insurers, health plans, providers, and patients to streamline claims reconciliation and ensure compliance with federal reporting requirements. Although revenue from this platform has not been significant, it is positioned to improve operational efficiency and reduce administrative burdens in healthcare reimbursement.
- EHR Platform: This segment offers a technologically advanced Electronic Health Record system enabling patients and authorized representatives to securely collect, distribute, and export their health data. Launched in the second quarter of 2024, the platform supports informed decision-making and improved health outcomes by streamlining medical data retrieval and analysis for patients and providers. Revenue generated from the EHR Platform has not been significant to date.
MSP Recovery holds a distinctive position in the healthcare data and claims recovery industry due to its model of receiving irrevocable assignments of recovery rights, which allows it to control litigation and pursue multiple legal theories unavailable to competitors relying on vendor contracts. Its competitive advantages include a large portfolio of assigned Claims valued at approximately $1.591 trillion in Billed Amount and $380 billion in Paid Amount, with about $87.7 billion in present value of potentially recoverable Claims as of December 31, 2024. The company differentiates itself from firms like Cotiviti Holdings, Claritev Corp., Optum, and Change Healthcare through its ownership of recovery rights, proprietary algorithms, and integrated legal and data analytics capabilities.
MSP Recovery serves a diverse customer base including Medicare Advantage Organizations (MAOs), Provider-Sponsored Organizations (PSOs), Hospitals, Medical Service Organizations (MSOs), Independent Physician Associations (IPAs), and other at-risk entities in the Medicare, Medicaid, and commercial insurance sectors. The company has received assignments from over 160 Assignors across all 50 states and Puerto Rico, reflecting a broad national footprint in its client relationships.