The Rawlings Group
The Rawlings Group is a US healthcare payment integrity firm that identifies and recovers overpayments for health insurance companies, HMOs, PPOs, and self-funded plans across subrogation, COB, pharmacy, and mass tort litigation services, founded in 1977 and acquired by Machinify in 2025.
- Company typePrivate
- Founded1977
- HeadquartersLa Grange, United States
- Headcount1,001–5,000
- GTM typeB2B
- OfferingServices
What The Rawlings Group does
The Rawlings Group (legal entity: The Rawlings Company LLC), founded in 1977 and headquartered at 1 Eden Parkway, La Grange, Kentucky, is a US healthcare payment integrity firm that identifies and recovers overpayments on behalf of health insurance companies, HMOs, PPOs, indemnity insurers, and self-funded health plans. Its service portfolio spans four core lines: medical subrogation and workers' compensation recovery, Medicare and commercial Coordination of Benefits (COB) recovery, drug claim payment integrity and pharmacy recovery, and legal services for mass tort and class action litigation. The firm pioneered the first medical subrogation outsourcing program for the healthcare industry in 1985 and the first pharmacy claims recovery program, and it represents over 80% of the private health insurance market in mass tort and class action cases, including major pharmaceutical liability matters such as silicone breast implant, Actos, Pelvic Mesh, NuvaRing, and Yaz litigation.
The company's technical platform combines proprietary data mining systems, automated anomaly detection, and machine learning models to scan structured healthcare claims for recoverable overpayments, supported by in-house data science and data integrity teams and codified regulatory expertise captured in the National Subrogation Law Manual (26th edition) and National Coordination of Benefits Law Manual (10th edition, 2023). Revenue is generated primarily through transaction-fee arrangements in which Rawlings recovers overpayments on behalf of clients and retains a portion of recovered amounts, supplemented by professional services fees for legal work and one-time license revenue from law manual sales to carriers, third-party administrators, and law school libraries. The go-to-market is direct enterprise sales to health plan decision-makers with dedicated client service representatives and multi-year contracts.
In 2025, Rawlings was acquired by Machinify, Inc., a healthcare AI company that has consolidated it alongside Apixio Holdings and Varis under a single corporate umbrella, positioning the combined platform to integrate payment integrity with clinical AI and risk-adjustment analytics. Prior to the acquisition the firm had no disclosed venture or private equity backing, and revenue figures are not publicly available.
The Rawlings Group firmographics
Firmographics- Name
- The Rawlings Group
- Legal name
- The Rawlings Company LLC
- Website
- https://rawlingscompany.com
- Company type
- Private
- Founded year
- 1977
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- The Rawlings Group is a US healthcare payment integrity firm that identifies and recovers overpayments for health insurance companies, HMOs, PPOs, and self-funded plans across subrogation, COB, pharmacy, and mass tort litigation services, founded in 1977 and acquired by Machinify in 2025.
- Ownership category
- akta.pro rank
The Rawlings Group industry classification
Industry- Product category
- Healthcare Payment Integrity and Claims Recovery Services
- NAICS
- Collection Agencies (561440)
- SIC
- Services-Consumer Credit Reporting, Collection Agencies (7320)
- akta.pro primary industry
- Legal Collections & Litigation Support (Judgments, Garnishments) (FSAKAJAD)
Keywords
Where The Rawlings Group is headquartered
LocationHeadquarters
- HQ city
- La Grange
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
The Rawlings Group business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales
Revenue model
- Claims Recovery Services: Revenue generated through payment integrity and recovery services for health plan clients including subrogation, workers compensation recovery, Medicare and commercial COB recovery, and pharmacy claims recovery. The company recovers overpayments on behalf of health plans and takes a portion of recovered amounts as fees.
- Legal Services: Legal services for mass tort and class action litigation, pharmaceutical marketing and pricing abuse cases, representing health insurers in recovery claims.
- Law Manual Publications: Sale of National Coordination of Benefits Law Manual and National Subrogation Law Manual publications to insurance carriers, TPAs, and law school libraries.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Other | Multi-year contract | Custom enterprise pricing based on recovery outcomes and client needs |
Go-to-market motion1 record
Distribution channels1 record
Marketing channels4 records
The Rawlings Group product offering
Product offeringCore offering
The Rawlings Group provides payment integrity and overpayment recovery services to health insurance companies, HMOs, PPOs, and self-funded health plans. Its offerings include Subrogation and Workers' Compensation Recovery, Medicare and Commercial Coordination of Benefits (COB) Recovery, Drug Claim Payment Integrity and Pharmacy Recovery, and Legal Services for mass tort and class action litigation. The company is compensated via contingency-based fees on amounts recovered and also sells industry-standard legal reference manuals.
Product overview
The Rawlings Group provides a comprehensive suite of healthcare payment integrity services designed to reduce healthcare costs for health insurance clients. The company operates as a platform of integrated recovery services including Subrogation & Workers' Compensation Recovery, Medicare and Commercial COB Recovery, Drug Claim Payment Integrity & Pharmacy Recovery, and Legal Services for mass tort litigation. These core services are complemented by proprietary technology using advanced data mining, AI, and machine learning systems developed internally. The company also publishes industry reference materials including the National Coordination of Benefits Law Manual and National Subrogation Law Manual. Rawlings is now part of Machinify, The Healthcare Intelligence Company.
Differentiator
Problem solved
Functional benefit
Products and services
- Subrogation & Workers' Compensation Recovery Services National subrogation outsourcing and workers' compensation recovery services for health insurance companies and self-funded health plans. Pioneered by Rawlings in 1985 as the first medical subrogation outsourcing program in healthcare.
- Medicare and Commercial Coordination of Benefits (COB) Recovery Services Medicare and commercial coordination of benefits claims review, identification and recovery services for health plans, with a focus on complex and difficult-to-identify investigations using the company's technology platform and legal expertise.
- Drug Claim Payment Integrity & Pharmacy Recovery Services
- Legal Services — Mass Tort & Class Action Litigation
- National Coordination of Benefits Law Manual Reference guide for COB claims management, administration and recovery, covering statutes and regulations across all 50 states. Sold to law departments, COB divisions of health insurance carriers, TPAs, and law school libraries.
- National Subrogation Law Manual The only national treatise on subrogation law, currently in its 26th edition, covering all 50 states and DC. Used as the expert resource by the entire industry for advice and guidance on subrogation law.
Quantifiable outcome
- Recover more money for health plan clients than any other competing vendor
- +3 more outcomes
Companies that use The Rawlings Group
Customer profileNamed customers3 records
Segments2 records
Ideal customer profiles3 records
The Rawlings Group technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability4 records
Feature5 records
The Rawlings Group partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- Machinify, Inc.coreThe Rawlings Group is now part of Machinify, The Healthcare Intelligence Company. Machinify is a healthcare AI company that has acquired The Rawlings Company LLC, Rawlings Financial Services LLC, Apixio Holdings LLC, and Varis, LLC under its corporate umbrella.
Scale indicators6 records
Recent moves6 records
Expansion highlights5 records
The Rawlings Group competitors and assessment
Company assessmentDirect peers
- Cotiviti: Cotiviti is a healthcare payment accuracy and integrity vendor offering claims accuracy, COB, subrogation, and risk-adjustment services to health plans. It is the closest direct competitor to Rawlings across payment integrity, especially COB and overpayment recovery.
- Gainwell Technologies: Gainwell (formerly part of HMS Holdings/CMS) delivers Medicaid payment integrity, coordination of benefits, and program integrity services to state Medicaid agencies, a market segment adjacent to Rawlings' Medicare COB recovery business.
- Zelis Healthcare: Zelis provides healthcare cost management and payment integrity solutions to health plans, including COB, claims editing, and subrogation-adjacent recovery services that compete with Rawlings in the payor market.
- Experian Health: Experian Health sells identity management, COB, and eligibility-based payment integrity solutions to US health plans, overlapping with Rawlings' Medicare/commercial COB recovery workflow.
- MultiPlan: MultiPlan provides cost-containment, payment integrity, and analytics services to payors, including COB, subrogation, and claim editing that overlap directly with Rawlings' recovery offerings. Its acquisition of SCIO Health analytics expanded its payment integrity footprint alongside Rawlings.
- Conduent: Conduent offers healthcare claims processing, payment integrity, and subrogation/coordination of benefits services to commercial and government payors, making it a direct peer in outsourced health-plan payment integrity.
- SCIO Health Analytics: SCIO Health Analytics (now part of MultiPlan) offers payment integrity, risk adjustment, and overpayment recovery analytics to health plans that are directly substitutable for Rawlings' COB and pharmacy recovery services.
Others
- Datavant: Datavant provides healthcare data connectivity and de-identification infrastructure used by payment-integrity vendors like Rawlings to link records across payors; while not a direct competitor, it is an ecosystem participant in the same recovery workflow.
Broad incumbents
- Optum (UnitedHealth Group): Optum's payment integrity and risk-adjustment business (built in part on Change Healthcare) offers subrogation, COB, and claims accuracy at scale inside a vertically integrated payor-services franchise, competing for the same health-plan RFPs as Rawlings.
- Change Healthcare: Change Healthcare (now part of Optum) provided payment accuracy, subrogation, and COB services to a broad payor base and competed directly with Rawlings in outsourced healthcare recovery.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
The Rawlings Group social profiles
Digital presenceThe Rawlings Group compliance and trust
Trust signalCompliance4 records
The Rawlings Group financial estimates
Financial estimateRevenue estimate
Valuation estimate
The Rawlings Group leadership team
Management profileNumber of profiles
Profiles1 record
The Rawlings Group funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
The Rawlings Group M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about The Rawlings Group
What does The Rawlings Group do?
The Rawlings Group provides payment integrity and overpayment recovery services to health insurance companies, HMOs, PPOs, and self-funded health plans. Its offerings include Subrogation and Workers' Compensation Recovery, Medicare and Commercial Coordination of Benefits (COB) Recovery, Drug Claim Payment Integrity and Pharmacy Recovery, and Legal Services for mass tort and class action litigation. The company is compensated via contingency-based fees on amounts recovered and also sells industry-standard legal reference manuals.
Is The Rawlings Group a public or private company?
The Rawlings Group is a private company. It is classified as corporate owned and is currently operating.
When was The Rawlings Group founded?
The Rawlings Group was founded in 1977. It employs 1,001 to 5,000 people.
Where is The Rawlings Group based?
The Rawlings Group is headquartered in La Grange, United States, in the North America region.
How does The Rawlings Group make money?
Three revenue lines are on record. Claims Recovery Services are the primary driver. The others are legal Services and law Manual Publications.
Who are The Rawlings Group's main competitors?
Direct peers on record are Cotiviti, Gainwell Technologies, Zelis Healthcare, Experian Health, MultiPlan, Conduent and SCIO Health Analytics. Datavant is listed as an others. Broad incumbents are Optum (UnitedHealth Group) and Change Healthcare.
Does The Rawlings Group have an API?
No public API is recorded for The Rawlings Group.
What industry is The Rawlings Group in?
The Rawlings Group's product category is Healthcare Payment Integrity and Claims Recovery Services. Its primary akta.pro industry code is FSAKAJAD, Legal Collections & Litigation Support (Judgments, Garnishments). Its NAICS code is 561440 and its SIC code is 7320.