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Artificial Intelligence (AI) and generative AI have the transformative potential to revolutionize the payment integrity industry. These advanced digital capabilities are no longer visionary concepts but live practices that empower team members to work at the top of their licenses. By employing a human-in-the-loop approach to AI, payment integrity professionals can operate beyond gathering and collating data and focus on making critical decisions while staying at the forefront of these industry-changing innovations. This session will share real-world use cases on how these technologies are enabling transformative change – and ultimately driving improved outcomes – including how to access and interpret both structured and unstructured data, automate the distillation of critical insights from data into actionable information, and expose payment integrity vulnerabilities and accelerate mitigation initiatives.

Payment Integrity

Author:

William O'Neill

Vice President – Product Management, Payment Integrity
EXL
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William O'Neill

Vice President – Product Management, Payment Integrity
EXL
Payment Integrity

Author:

Anthony Baize

Inspector General
Wisconsin Department of Health Services

Anthony J. Baize is the Inspector General for the Wisconsin Department of Health Services.  Baize took the position in early 2016 after eight years with Kentucky state government in the Kentucky Cabinet for Health and Family Services, serving as the Deputy Director of Audits and Investigations for the Office of Inspector General and the Director of Business Informatics with the Department of Behavioral Health, Developmental and Intellectual Disabilities.

Baize has served as the Region V representative for the National Association of Medicaid Program Integrity Directors and on the Advisory Board for the Centers for Medicare and Medicaid Services’ Medicaid Integrity Institute.  He regularly speaks at national conferences on topics related to Medicaid Program Integrity. 

Baize became a certified inspector general in 2022 after completing the Association of Inspectors General Institute.  He is also a member of the Internation Association of Financial Crimes Investigators.      

Baize was a civil rights consultant for nearly 20 years, serving on the Board of Directors for the National Fair Housing Alliance and the Lexington (KY) Fair Housing Council. Baize has given presentations on fair housing requirements across the United States, but especially in Kentucky, Indiana, Ohio and Tennessee.  He has a master’s degree in public administration from Indiana State University, has been married for 29 years and has two daughters. 

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Anthony Baize

Inspector General
Wisconsin Department of Health Services

Anthony J. Baize is the Inspector General for the Wisconsin Department of Health Services.  Baize took the position in early 2016 after eight years with Kentucky state government in the Kentucky Cabinet for Health and Family Services, serving as the Deputy Director of Audits and Investigations for the Office of Inspector General and the Director of Business Informatics with the Department of Behavioral Health, Developmental and Intellectual Disabilities.

Baize has served as the Region V representative for the National Association of Medicaid Program Integrity Directors and on the Advisory Board for the Centers for Medicare and Medicaid Services’ Medicaid Integrity Institute.  He regularly speaks at national conferences on topics related to Medicaid Program Integrity. 

Baize became a certified inspector general in 2022 after completing the Association of Inspectors General Institute.  He is also a member of the Internation Association of Financial Crimes Investigators.      

Baize was a civil rights consultant for nearly 20 years, serving on the Board of Directors for the National Fair Housing Alliance and the Lexington (KY) Fair Housing Council. Baize has given presentations on fair housing requirements across the United States, but especially in Kentucky, Indiana, Ohio and Tennessee.  He has a master’s degree in public administration from Indiana State University, has been married for 29 years and has two daughters. 

Author:

Ray Evans

Vice President of Healthcare Sales
CoventBridge Group

Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.

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Ray Evans

Vice President of Healthcare Sales
CoventBridge Group

Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.

Author:

Amanda Brown

Vice President - Revenue Integrity
CoventBridge Group

Amanda Brown is the Vice President of Revenue Integrity at CoventBridge Group where she provides expertise to her clients spanning Medicare Advantage, Medicare Part D, Medicaid, Marketplace, Commercial and FEHB products. She is a subject matter expert in the design and implementation of effective compliance, program integrity, risk, audit, vendor oversight, and ethics programs. Amanda has a keen ability to break down silos and bring organizational collaboration to facilitate compliance with policies, laws, regulations, and risk management.

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Amanda Brown

Vice President - Revenue Integrity
CoventBridge Group

Amanda Brown is the Vice President of Revenue Integrity at CoventBridge Group where she provides expertise to her clients spanning Medicare Advantage, Medicare Part D, Medicaid, Marketplace, Commercial and FEHB products. She is a subject matter expert in the design and implementation of effective compliance, program integrity, risk, audit, vendor oversight, and ethics programs. Amanda has a keen ability to break down silos and bring organizational collaboration to facilitate compliance with policies, laws, regulations, and risk management.

Join us for an enlightening fireside chat that delves into the powerful relationship between data mining and Coordination of Benefits (COB) in the healthcare industry. As health plans strive for efficiency and cost-effectiveness, understanding how to integrate sophisticated data analytics into COB processes is crucial for maximizing total plan value.

  • Understand the integration of data mining to enhance COB efficiency.
  • Learn strategies for utilizing data insights to achieve cost savings and maximize plan value.
  • Gain awareness of challenges and future trends in data-driven COB processes.
Payment Integrity

Author:

Kyle Pankey

Sales & Growth Leader
Carelon Subrogation

Kyle Pankey has over two decades of experience working within the healthcare and payer operations, with over 10 years specifically tied in to the payment integrity space.   Kyle lives in Chattanooga, TN and has served as Carelon Subrogation’s growth leader since mid-2022.

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Kyle Pankey

Sales & Growth Leader
Carelon Subrogation

Kyle Pankey has over two decades of experience working within the healthcare and payer operations, with over 10 years specifically tied in to the payment integrity space.   Kyle lives in Chattanooga, TN and has served as Carelon Subrogation’s growth leader since mid-2022.

Author:

Beth Franke

Staff Vice President, Payment Integrity Coordination of Benefits
Elevance/Anthem

Beth Franke started her career in the healthcare industry over 30 years ago. During that time, she has held management and leadership positions within large healthcare organizations such as Elevance Heath, Humana, Inc. and Kindred Healthcare and served as principal consultant for the Commonwealth of Kentucky, launching the state’s first self-funded health insurance model. She has also managed multi-discipline teams within special investigations, claims, enrollment and billing, corporate applications, mobile strategy, care management and enterprise project management office. Her current role as Staff Vice President has positioned her to oversee the Coordination of Benefits organization in Payment Integrity with over 500+ associates.

Beth has a BS in Mathematics and Computer Science from Centre College. She is a Project Management Professional (PMP), a Certified Professional Coder (CPC) and earned a Master Six Sigma Black Belt (MBB) certification from Villanova University. She also serves as a certified professional coach and was recognized as an Emerging Leader at Elevance Health.

Beth and her husband line in Louisville, KY and have five adult children. She enjoys hiking, biking and traveling with her family and is also active with several volunteer organizations, providing food, shelter, and other needed services for those less fortunate.

... read more

Beth Franke

Staff Vice President, Payment Integrity Coordination of Benefits
Elevance/Anthem

Beth Franke started her career in the healthcare industry over 30 years ago. During that time, she has held management and leadership positions within large healthcare organizations such as Elevance Heath, Humana, Inc. and Kindred Healthcare and served as principal consultant for the Commonwealth of Kentucky, launching the state’s first self-funded health insurance model. She has also managed multi-discipline teams within special investigations, claims, enrollment and billing, corporate applications, mobile strategy, care management and enterprise project management office. Her current role as Staff Vice President has positioned her to oversee the Coordination of Benefits organization in Payment Integrity with over 500+ associates.

Beth has a BS in Mathematics and Computer Science from Centre College. She is a Project Management Professional (PMP), a Certified Professional Coder (CPC) and earned a Master Six Sigma Black Belt (MBB) certification from Villanova University. She also serves as a certified professional coach and was recognized as an Emerging Leader at Elevance Health.

Beth and her husband line in Louisville, KY and have five adult children. She enjoys hiking, biking and traveling with her family and is also active with several volunteer organizations, providing food, shelter, and other needed services for those less fortunate.

Author:

Jennifer Bellcour

Director Carelon Payment Integrity Solutions, Data Mining
Carelon

Jennifer Bellcour is a seasoned leader in payment integrity, currently serving as the Director of Carelon Payment Integrity Solutions, Data Mining. With over 20 years at the company, she has been instrumental in advancing prepay data mining and claims anomaly detection initiatives. Known for her expertise, Jennifer excels at developing talent and building impactful teams to drive innovation. Her diverse background includes claims, billing, customer service, and training, and she is adept at partnering with global teams to support change management. Jennifer holds a Bachelor's degree from Southern New Hampshire University and a Master of Science in Management and Leadership (MSML) from Western Governors University.

... read more

Jennifer Bellcour

Director Carelon Payment Integrity Solutions, Data Mining
Carelon

Jennifer Bellcour is a seasoned leader in payment integrity, currently serving as the Director of Carelon Payment Integrity Solutions, Data Mining. With over 20 years at the company, she has been instrumental in advancing prepay data mining and claims anomaly detection initiatives. Known for her expertise, Jennifer excels at developing talent and building impactful teams to drive innovation. Her diverse background includes claims, billing, customer service, and training, and she is adept at partnering with global teams to support change management. Jennifer holds a Bachelor's degree from Southern New Hampshire University and a Master of Science in Management and Leadership (MSML) from Western Governors University.

Payment Integrity

Uncover Emerging Threats: HCFS shares insights from working with leading health plans, highlighting rising fraud schemes and patterns they’ve detected across the industry.

Prepare for 2025: Gain actionable knowledge on upcoming FWA challenges and learn strategies to strengthen your fraud detection processes, ensuring your organization stays ahead in the evolving landscape.

Payment Integrity

Author:

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

... read more

Karen Weintraub

Executive Vice President
HEALTHCARE FRAUD SHIELD

With 25 years of data and 20 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, a Certified Dental Coder (CDC) from the American Dental Association, and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college. 

In today’s complex healthcare ecosystem, interoperability - the seamless exchange and utilization of data across diverse systems - is the linchpin for success in payment integrity and risk adjustment. When health plans, payers, providers, and vendors collaborate through standardized and efficient data sharing, the results are transformative: accurate payments, fraud prevention, and streamlined processes that scale innovation. However, the absence of a disciplined interoperability strategy can lead to significant inefficiencies.


This keynote will emphasize the critical need for a proactive, stakeholder-driven interoperability plan. Drawing parallels to Six Sigma principles, it highlights how early standardization of data formats, security protocols, and transfer methods prevent downstream inefficiencies, reduce costs, and enhance scalability. Attendees will leave with actionable insights into how interoperability not only smooths immediate business processes but also lays the foundation for long-term industry transformation.


Join us to explore why interoperability isn’t just a technical challenge but a strategic imperative—an essential cornerstone for a resilient, innovative, and efficient healthcare system.

Lesson Objectives:

- Understand the Impact of Interoperability: Learn how seamless data exchange and standardization, improve operational efficiency.
- Explore Real-World Lessons: Case studies help underscore the consequences of poor interoperability planning and the benefits of thoughtful standardization.
- Actionable Strategies for Stakeholder Collaboration: Discover how to develop a disciplined interoperability plan.

Payment Integrity

Author:

Dave Cardelle

Chief Strategy Officer
AMS
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Dave Cardelle

Chief Strategy Officer
AMS