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Healthcare Payment Integrity Pioneer | Strategic Advisor | SaaS Innovator

With over 45 years of healthcare experience and leadership, David V. Cardelle is one of the nation’s foremost authorities in payment integrity, cost containment, and claims analytics. A registered pharmacist and serial innovator, Dave co-founded one of the first third-party audit firms in the U.S.  As one of the first contingency based payment integrity vendors selling comprehensive audit and recovery services into health plans, Dave helped define the modern PI industry. He went on to build and lead some of the most successful payment integrity companies in the country, generating several billions of dollars in recoveries and cost avoidance. Providing services to the smallest and largest health plans in the country, his consistent focus on the customer combined with building teams of mastery level subject matter experts, built a track record of continuous year over year growth, for several decades. Leading the original asset through various transactions and ownership changes, at times a smaller division within different multi-billion dollar organizations, organic growth from first dollar to an asset value of over $1.4B was achieved. During this growth trajectory, the payment integrity industry itself changed from being a “nice to have” to a necessity for all health plans.

Today, as Chief Strategy Officer of AMS, Dave is at the forefront of transforming PI through AI-driven audit automation, price transparency technology, and predictive analytics. His primary focus is on building innovative and strategic, subscription based software and transparent PI content for insourcing models, disrupting the contingency vendor industry he once help build. Dave’s expertise spans the full spectrum of post-payment, pre-payment and now pre-submission, payment integrity.

Known for blending operational rigor with bold innovation, Dave is a sought-after speaker, advisor, and thought leader-trusted by health plans, TPAs, brokers, and government agencies alike.

“The more complex the contract language, the more errors will occur. Healthcare contracts have become increasingly complex over the years, from FFS, to DRG, to Carve-out contracts. It is no surprise that denials, audits and overpayments continue to grow every year.”