Fraud schemes are becoming more scalable and harder to detect, while payers are racing to deploy AI defensively. Fake medical records, clinical documentation and images, alongside AI’s ability to generate false claims at scale, are among the quickly emerging drivers of fraud. These trends make it imperative that payers re-think fraud detection, focusing on proactive behavior prediction that aligns with pre-pay cost avoidance strategies.
- The fastest growing new schemes driven by synthetic and AI generated fraud
- How to leverage new AI capabilities to detect fraud including behavioral patterns in pre-pay
- How to anticipate the ‘next big thing’ in fraud before it happens
In partnership with Healthcare Fraud Shield
Karen Weintraub
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.
