AI Summit
October 6-7, 2026 | Atlanta, GA
Porsche Experience Center & Kimpton Overland Hotel
Event Agenda
This is not your average conference reception—prepare for an exhilarating start to the AI Summit.
Tuesday, October 6th | Porsche Experience Center
AI Summit Kickoff: Welcome Reception & Porsche Experiences
|
4:30 PM – 6:30 PM |
Simulator Lab Experience Drop into the Porsche Experience Simulator Lab anytime between 4:30-6:30 PM for a unique simulated driving experience. Visitors can choose from a number of iconic Porsche street and track race cars with highly authentic physics and performance characteristics. |
|
6:00 PM – 8:00 PM |
Welcome Reception + Hot Laps Join us for the summit’s official kickoff, where you can network with fellow executives amidst the exhilarating world of Porsche’s legendary engineering. Enjoy food and drinks, and for those seeking an extra thrill, experience the track firsthand with professionally-led hot laps. |
Wednesday, October 7th | Kimpton Overland Hotel
AI Summit 2026: Executive Program
|
8:00 AM – 9:00 AM |
Breakfast & Networking |
|
9:00 AM – 9:30 AM |
Opening Keynote Address: The Forces Reshaping Payment Integrity Dr. Musheer Ahmed opens the summit by examining the converging market forces fundamentally challenging traditional payment integrity models. An aging population is driving exponential claims growth. Sophisticated fraud schemes cost the industry $400 billion annually. Providers are overwhelmed by administrative burden. And trust between payers and providers has eroded to where distrust is the operating norm. Against this backdrop, payers face mounting pressure to increase savings and reduce costs—demands the current pay-and-chase model cannot meet. Dr. Ahmed will discuss why incremental improvements are no longer sufficient and preview the practitioner insights, case studies, and strategic perspectives attendees will hear throughout the summit as they explore how leading organizations are moving payment integrity further upstream than ever before.
 Dr. Musheer Ahmed, PhD
|
|
9:30 AM – 10:15 AM |
Opening Keynote Address Keynote details to be announced. |
|
10:15 AM – 11:00 AM |
One Year Later: Payment Integrity’s Shift from Vision to Reality — Moving Beyond Fragmented, Recovery-Focused Models A year ago, the conversation around moving payment integrity upstream was largely theoretical. Today, it’s becoming operational reality. Drawing on her experience building a unified platform across payers, providers, and PBMs at Judi Health | Capital Rx, this session explores what it actually takes to move beyond fragmented, recovery-based models and intervene earlier — before cost, friction, and rework are introduced into the system. For payer executives navigating cost containment strategy in 2026, the session challenges a foundational assumption — that downstream recovery and adversarial processes are the only path. The conversation examines whether a better model is now within reach: one that reduces administrative burden, strengthens provider relationships, and drives meaningful cost avoidance at the source.
 Lynn Garbee
|
|
11:00 AM – 11:15 AM |
Break |
|
11:15AM – 12:00 PM |
Rethinking Provider Engagement: Why One Health Plan Redesigned Its Approach to Provider Education Provider education programs are meant to improve billing accuracy and reduce payment errors—but too often, they create more friction than improvement. Dr. Priscilla Alfaro shares some provider challenges inside Blue Cross NC’s provider engagement, trends in coding, and education programs that prompted leadership to fundamentally rethink their approach. She’ll discuss the internal pressures driving change, the business case for transformation, and how they’re measuring success differently now—beyond just dollars saved to include provider experience metrics.
 Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE, CRC
|
|
12:00 PM – 12:30 PM |
Fireside Chat: AI and the Integrity of the Claim—Coding, Fraud, and What’s Changing As AI becomes more embedded in healthcare workflows, it is beginning to influence not just how claims are reviewed—but how they are created. From AI-assisted coding that can increase billing intensity to AI-enabled fraud and manipulated documentation, the integrity of the claim itself is changing in ways that traditional payment integrity and SIU approaches weren’t designed to address. In this fireside chat, Kurt Spear shares how these shifts are starting to surface in real investigations—from changes in coding patterns to more sophisticated forms of fraud, including AI-generated or altered records. The discussion will focus on what SIU teams are actually seeing, where existing detection methods are falling short, and how investigative strategies are evolving in response. Speaker:  Kurt Spear, CFE, CISSP
Moderator:
 Jim Brady
|
|
12:30 PM – 1:30 PM |
Lunch & Networking |
|
1:30 PM – 2:15 PM |
Government Programs in the AI Era: Balancing Innovation, Compliance, and Fiscal Accountability Government programs face distinct pressures when adopting AI for payment integrity—stringent regulatory oversight, budget constraints, network adequacy concerns, and heightened scrutiny from CMS and state legislators. This panel brings together legal/compliance, government oversight, and Medicaid managed care operational perspectives to explore how government programs navigate AI adoption while managing these competing demands. Panelists will discuss the unique considerations for Medicaid and Medicare programs, how to build internal business cases that satisfy fiscal and political stakeholders, and strategies for implementing innovation without compromising compliance or provider access. Panelists:
 Michael J. Velezis
 Sonja Allen-Smith
 Tom Martin
|
|
2:15 PM – 3:00 PM |
Operationalizing AI in Healthcare: Overcoming Barriers and Realizing Value Across healthcare payers, AI initiatives often stall not because of model performance, but because of breakdowns across people, processes, and technology. Drawing from hands-on work with payer organizations, this session examines the most common barriers leaders encounter when moving AI from pilot to production—organizational readiness, workflow fit, data quality, integrations, governance, and change management. The discussion focuses on practical lessons executives can apply immediately: how successful teams sequence adoption, align stakeholders, set guardrails, and avoid common missteps that erode trust or delay value. Speaker:
 Joanne Galimi
|
|
3:00 PM – 3:15 PM |
Break |
|
3:15 PM – 4:00 PM |
The Road Ahead—Strategic Priorities for Payer Leaders Drawing from his experience as SVP at Blue Cross Blue Shield of Michigan and now advising multiple health plans through Perspectiv Health, Dr. Aaron Friedkin offers a strategic view of what’s ahead for payment integrity. This session moves beyond individual tactics to examine the broader organizational shifts payer leaders must navigate over the next 12–24 months. Dr. Friedkin will discuss how upstream AI is becoming a competitive differentiator, what separates organizations that successfully operationalize innovation from those that stall in pilot mode, and where executive attention needs to focus—from technology selection to organizational readiness to provider partnership models. With a unique vantage point spanning C-suite decision-making and cross-industry advisory work, he’ll share what he’s seeing work across multiple organizations, where the biggest gaps remain, and what bold moves are required to position payment integrity as a strategic advantage rather than an operational cost center. |
|
4:00 PM – 4:30 PM |
The Role of Humans in a World Powered by AI As AI investment accelerates at an unprecedented pace, healthcare leaders are under increasing pressure to translate that investment into measurable value—while navigating uncertainty around workforce impact, domain expertise, and governance. This session explores what these shifts mean specifically for payment integrity organizations. From setting realistic expectations for ROI, to preserving the human expertise that underpins accurate decision-making, to defining what responsible AI actually looks like in practice, the discussion will focus on the challenges leaders are actively working through today. Rather than presenting a fixed playbook, this session offers a candid perspective on where the industry is still evolving—and what organizations should be doing now to ensure AI strengthens, rather than erodes, the long-term effectiveness of their payment integrity programs.
Speaker:
 Jenny Karuna
|
|
4:30 PM – 5:00 PM |
Closing Remarks: What Happens Next Dr. Musheer Ahmed closes the summit by reflecting on the day’s conversations and challenging attendees to move from insight to action. He’ll highlight the key themes that emerged—the urgency for upstream intervention, the need to rebuild provider trust, the operational realities of AI adoption, and the competitive advantage that early movers are gaining. More importantly, he’ll address what needs to happen when attendees return to their organizations: the conversations to have with leadership, the business cases to build, the pilot programs to launch, and the partners to engage. This isn’t the end of a conference—it’s the beginning of a transformation.
Dr. Musheer Ahmed, PhD
|
Tuesday, October 6th | Porsche Experience Center
AI Summit Kickoff: Welcome Reception & Porsche Experiences
|
4:30 PM – 6:30 PM |
Simulator Lab Experience Drop into the Porsche Experience Simulator Lab anytime between 4:30-6:30 PM for a unique simulated driving experience. Visitors can choose from a number of iconic Porsche street and track race cars with highly authentic physics and performance characteristics. |
|
6:00 PM – 8:00 PM |
Welcome Reception + Hot Laps Join us for the summit’s official kickoff, where you can network with fellow executives amidst the exhilarating world of Porsche’s legendary engineering. Enjoy food and drinks, and for those seeking an extra thrill, experience the track firsthand with professional-led hot laps. |
Wednesday, October 7th | Kimpton Overland Hotel
AI Summit 2026: Executive Program
|
8:00 AM – 9:00 AM |
Breakfast & Networking |
|
9:00 AM – 9:30 AM |
Opening Keynote Address: The Forces Reshaping Payment Integrity Dr. Musheer Ahmed opens the summit by examining the converging market forces fundamentally challenging traditional payment integrity models. An aging population is driving exponential claims growth. Sophisticated fraud schemes cost the industry $400 billion annually. Providers are overwhelmed by administrative burden. And trust between payers and providers has eroded to where distrust is the operating norm. Against this backdrop, payers face mounting pressure to increase savings and reduce costs—demands the current pay-and-chase model cannot meet. Dr. Ahmed will discuss why incremental improvements are no longer sufficient and preview the practitioner insights, case studies, and strategic perspectives attendees will hear throughout the summit as they explore how leading organizations are moving payment integrity further upstream than ever before.
Dr. Musheer Ahmed, PhD
|
|
9:30 AM – 10:15 AM |
Opening Keynote Address Keynote details to be announced. |
|
10:15 AM – 11:00 AM |
One Year Later: Payment Integrity’s Shift from Vision to Reality — Moving Beyond Fragmented, Recovery-Focused Models A year ago, the conversation around moving payment integrity upstream was largely theoretical. Today, it’s becoming operational reality. Drawing on her experience building a unified platform across payers, providers, and PBMs at Judi Health | Capital Rx, this session explores what it actually takes to move beyond fragmented, recovery-based models and intervene earlier — before cost, friction, and rework are introduced into the system. For payer executives navigating cost containment strategy in 2026, the session challenges a foundational assumption — that downstream recovery and adversarial processes are the only path. The conversation examines whether a better model is now within reach: one that reduces administrative burden, strengthens provider relationships, and drives meaningful cost avoidance at the source.
Lynn Garbee
|
|
11:00 AM – 11:15 AM |
Break |
|
11:15AM – 12:00 PM |
Rethinking Provider Engagement: Why One Health Plan Redesigned Its Approach to Provider Education Provider education programs are meant to improve billing accuracy and reduce payment errors—but too often, they create more friction than improvement. Dr. Priscilla Alfaro shares some provider challenges inside Blue Cross NC’s provider engagement, trends in coding, and education programs that prompted leadership to fundamentally rethink their approach. She’ll discuss the internal pressures driving change, the business case for transformation, and how they’re measuring success differently now—beyond just dollars saved to include provider experience metrics.
Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE, CRC
|
|
12:00 PM – 12:30 PM |
Fireside Chat: AI and the Integrity of the Claim—Coding, Fraud, and What’s Changing As AI becomes more embedded in healthcare workflows, it is beginning to influence not just how claims are reviewed—but how they are created. From AI-assisted coding that can increase billing intensity to AI-enabled fraud and manipulated documentation, the integrity of the claim itself is changing in ways that traditional payment integrity and SIU approaches weren’t designed to address. In this fireside chat, Kurt Spear shares how these shifts are starting to surface in real investigations—from changes in coding patterns to more sophisticated forms of fraud, including AI-generated or altered records. The discussion will focus on what SIU teams are actually seeing, where existing detection methods are falling short, and how investigative strategies are evolving in response. Speaker: Kurt Spear, CFE, CISSP
Moderator:
Jim Brady
|
|
12:30 PM – 1:30 PM |
Lunch & Networking |
|
1:30 PM – 2:15 PM |
Government Programs in the AI Era: Balancing Innovation, Compliance, and Fiscal Accountability Government programs face distinct pressures when adopting AI for payment integrity—stringent regulatory oversight, budget constraints, network adequacy concerns, and heightened scrutiny from CMS and state legislators. This panel brings together legal/compliance, government oversight, and Medicaid managed care operational perspectives to explore how government programs navigate AI adoption while managing these competing demands. Panelists will discuss the unique considerations for Medicaid and Medicare programs, how to build internal business cases that satisfy fiscal and political stakeholders, and strategies for implementing innovation without compromising compliance or provider access. Panelists:
Michael J. Velezis
Sonja Allen-Smith
Tom Martin
|
|
2:15 PM – 3:00 PM |
Operationalizing AI in Healthcare: Overcoming Barriers and Realizing Value Across healthcare payers, AI initiatives often stall not because of model performance, but because of breakdowns across people, processes, and technology. Drawing from hands-on work with payer organizations, this session examines the most common barriers leaders encounter when moving AI from pilot to production—organizational readiness, workflow fit, data quality, integrations, governance, and change management. The discussion focuses on practical lessons executives can apply immediately: how successful teams sequence adoption, align stakeholders, set guardrails, and avoid common missteps that erode trust or delay value. Speaker:
Joanne Galimi
|
|
3:00 PM – 3:15 PM |
Break |
|
3:15 PM – 4:00 PM |
The Road Ahead—Strategic Priorities for Payer Leaders Drawing from his experience as SVP at Blue Cross Blue Shield of Michigan and now advising multiple health plans through Perspectiv Health, Dr. Aaron Friedkin offers a strategic view of what’s ahead for payment integrity. This session moves beyond individual tactics to examine the broader organizational shifts payer leaders must navigate over the next 12–24 months. Dr. Friedkin will discuss how upstream AI is becoming a competitive differentiator, what separates organizations that successfully operationalize innovation from those that stall in pilot mode, and where executive attention needs to focus—from technology selection to organizational readiness to provider partnership models. With a unique vantage point spanning C-suite decision-making and cross-industry advisory work, he’ll share what he’s seeing work across multiple organizations, where the biggest gaps remain, and what bold moves are required to position payment integrity as a strategic advantage rather than an operational cost center. |
|
4:00 PM – 4:30 PM |
The Role of Humans in a World Powered by AI As AI investment accelerates at an unprecedented pace, healthcare leaders are under increasing pressure to translate that investment into measurable value—while navigating uncertainty around workforce impact, domain expertise, and governance. This session explores what these shifts mean specifically for payment integrity organizations. From setting realistic expectations for ROI, to preserving the human expertise that underpins accurate decision-making, to defining what responsible AI actually looks like in practice, the discussion will focus on the challenges leaders are actively working through today. Rather than presenting a fixed playbook, this session offers a candid perspective on where the industry is still evolving—and what organizations should be doing now to ensure AI strengthens, rather than erodes, the long-term effectiveness of their payment integrity programs.
Speaker:
Jenny Karuna
|
|
4:30 PM – 5:00 PM |
Closing Remarks: What Happens Next Dr. Musheer Ahmed closes the summit by reflecting on the day’s conversations and challenging attendees to move from insight to action. He’ll highlight the key themes that emerged—the urgency for upstream intervention, the need to rebuild provider trust, the operational realities of AI adoption, and the competitive advantage that early movers are gaining. More importantly, he’ll address what needs to happen when attendees return to their organizations: the conversations to have with leadership, the business cases to build, the pilot programs to launch, and the partners to engage. This isn’t the end of a conference—it’s the beginning of a transformation.
Dr. Musheer Ahmed, PhD
|
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Full Agenda
Tuesday, October 6 | Porsche Experience Center
AI Summit Kickoff: Welcome Reception & Porsche Experiences
4:30 PM – 6:30 PM
Simulator Lab Experience
Porsche Experience Center | Simulator Lab (Second Floor)
Drop into the Porsche Experience Simulator Lab anytime between 4:30-6:30 PM for a unique simulated driving experience. Visitors can choose from a number of iconic Porsche street and track race cars with highly authentic physics and performance characteristics.
6:00 PM – 8:00 PM
Welcome Reception + Hot Laps Porsche Experience Center | Carrera Café (Second Floor)
Join us for the summit’s official kickoff, where you can network with fellow executives amidst the exhilarating world of Porsche’s legendary engineering. Enjoy food and drinks, and for those seeking an extra thrill, experience the track firsthand with professionally-led hot laps.
Wednesday, October 7 | Kimpton Overland Hotel
AI Summit 2026: Executive Program
8:00 AM – 9:00 AM
Breakfast & Networking
9:00 AM – 9:30 AM
Opening Address: The Forces Reshaping Payment Integrity
Dr. Musheer Ahmed opens the summit by examining the converging market forces fundamentally challenging traditional payment integrity models. An aging population is driving exponential claims growth. Sophisticated fraud schemes cost the industry $400 billion annually. Providers are overwhelmed by administrative burden. And trust between payers and providers has eroded to where distrust is the operating norm.
Against this backdrop, payers face mounting pressure to increase savings and reduce costs—demands the current pay-and-chase model cannot meet. Dr. Ahmed will discuss why incremental improvements are no longer sufficient and preview the practitioner insights, case studies, and strategic perspectives attendees will hear throughout the summit as they explore how leading organizations are moving payment integrity further upstream than ever before.
Dr. Musheer Ahmed, PhD
Founder of the AI for PI Community
9:30 AM – 10:15 AM
Opening Keynote Address
Keynote details to be announced.
10:15 – 11:00 AM
One Year Later: Payment Integrity’s Shift from Vision to Reality — Moving Beyond Fragmented, Recovery-Focused Models
A year ago, the conversation around moving payment integrity upstream was largely theoretical. Today, it’s becoming operational reality. Drawing on her experience building a unified platform across payers, providers, and PBMs at Judi Health | Capital Rx, this session explores what it actually takes to move beyond fragmented, recovery-based models and intervene earlier — before cost, friction, and rework are introduced into the system.
For payer executives navigating cost containment strategy in 2026, the session challenges a foundational assumption — that downstream recovery and adversarial processes are the only path. The conversation examines whether a better model is now within reach: one that reduces administrative burden, strengthens provider relationships, and drives meaningful cost avoidance at the source.
Lynn Garbee, SVP
Managed Services, Judi Health | Capital Rx
11:00 AM – 11:15 AM
Break
11:15 – 12:00 PM
Rethinking Provider Engagement: Why One Health Plan Redesigned Its Approach to Provider Education
Provider education programs are meant to improve billing accuracy and reduce payment errors—but too often, they create more friction than improvement. Dr. Priscilla Alfaro shares some provider challenges inside Blue Cross NC’s provider engagement, trends in coding, and education programs that prompted leadership to fundamentally rethink their approach. She’ll discuss the internal pressures driving change, the business case for transformation, and how they’re measuring success differently now—beyond just dollars saved to include provider experience metrics.
Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE, CRC
VP Payment Integrity, Blue Cross NC
12:00 PM – 12:30 PM
Fireside Chat: AI and the Integrity of the Claim—Coding, Fraud, and What’s Changing
As AI becomes more embedded in healthcare workflows, it is beginning to influence not just how claims are reviewed—but how they are created. From AI-assisted coding that can increase billing intensity to AI-enabled fraud and manipulated documentation, the integrity of the claim itself is changing in ways that traditional payment integrity and SIU approaches weren’t designed to address.
In this fireside chat, Kurt Spear shares how these shifts are starting to surface in real investigations—from changes in coding patterns to more sophisticated forms of fraud, including AI-generated or altered records. The discussion will focus on what SIU teams are actually seeing, where existing detection methods are falling short, and how investigative strategies are evolving in response.
Speaker:
Kurt Spear, CFE, CISSP
VP Financial Investigation and Provider Review, Highmark Blue Cross Blue Shield
Moderator:
Jim Brady
VP of Growth, Codoxo
12:30 PM – 1:30 PM
Lunch & Networking
1:30 PM – 2:15 PM
Government Programs in the AI Era: Balancing Innovation, Compliance, and Fiscal Accountability
Government programs face distinct pressures when adopting AI for payment integrity—stringent regulatory oversight, budget constraints, network adequacy concerns, and heightened scrutiny from CMS and state legislators. This panel brings together legal/compliance, government oversight, and Medicaid managed care operational perspectives to explore how government programs navigate AI adoption while managing these competing demands. Panelists will discuss the unique considerations for Medicaid and Medicare programs, how to build internal business cases that satisfy fiscal and political stakeholders, and strategies for implementing innovation without compromising compliance or provider access.
Michael J. Velezis
Vice President and General Counsel, BCBS AL
Sonja Allen-Smith
CFO, DCH GA (Inspector General)
Tom Martin
VP Payment Integrity, AmeriHealth Caritas
2:15 PM – 3:00 PM
Operationalizing AI in Healthcare: Overcoming Barriers and Realizing Value
Across healthcare payers, AI initiatives often stall not because of model performance, but because of breakdowns across people, processes, and technology. Drawing from hands-on work with payer organizations, this session examines the most common barriers leaders encounter when moving AI from pilot to production—organizational readiness, workflow fit, data quality, integrations, governance, and change management. The discussion focuses on practical lessons executives can apply immediately: how successful teams sequence adoption, align stakeholders, set guardrails, and avoid common missteps that erode trust or delay value.
Joanne Galimi
Sr Managing Partner, Market Lead, Gartner
3:00 PM – 3:15 PM
Break
3:15 PM – 4:00 PM
The Road Ahead—Strategic Priorities for Payer Leaders
Drawing from his experience as SVP at Blue Cross Blue Shield of Michigan and now advising multiple health plans through Perspectiv Health, Dr. Aaron Friedkin offers a strategic view of what’s ahead for payment integrity. This session moves beyond individual tactics to examine the broader organizational shifts payer leaders must navigate over the next 12–24 months. Dr. Friedkin will discuss how upstream AI is becoming a competitive differentiator, what separates organizations that successfully operationalize innovation from those that stall in pilot mode, and where executive attention needs to focus—from technology selection to organizational readiness to provider partnership models. With a unique vantage point spanning C-suite decision-making and cross-industry advisory work, he’ll share what he’s seeing work across multiple organizations, where the biggest gaps remain, and what bold moves are required to position payment integrity as a strategic advantage rather than an operational cost center.
4:00 PM – 4:30 PM
The Role of Humans in a World Powered by AI
As AI investment accelerates at an unprecedented pace, healthcare leaders are under increasing pressure to translate that investment into measurable value—while navigating uncertainty around workforce impact, domain expertise, and governance.
This session explores what these shifts mean specifically for payment integrity organizations. From setting realistic expectations for ROI, to preserving the human expertise that underpins accurate decision-making, to defining what responsible AI actually looks like in practice, the discussion will focus on the challenges leaders are actively working through today.
Rather than presenting a fixed playbook, this session offers a candid perspective on where the industry is still evolving—and what organizations should be doing now to ensure AI strengthens, rather than erodes, the long-term effectiveness of their payment integrity programs.
Jenny Karuna
Chief Product Officer, Katch
4:30 PM – 5:00 PM
Closing Remarks: What Happens Next
Dr. Musheer Ahmed closes the summit by reflecting on the day’s conversations and challenging attendees to move from insight to action. He’ll highlight the key themes that emerged—the urgency for upstream intervention, the need to rebuild provider trust, the operational realities of AI adoption, and the competitive advantage that early movers are gaining.
More importantly, he’ll address what needs to happen when attendees return to their organizations: the conversations to have with leadership, the business cases to build, the pilot programs to launch, and the partners to engage. This isn’t the end of a conference—it’s the beginning of a transformation.
Dr. Musheer Ahmed, PhD
Founder of the AI for PI Community
Tuesday, October 6th
Tuesday, October 6 | Porsche Experience Center
AI Summit Kickoff: Welcome Reception & Porsche Experiences
4:30 PM – 6:30 PM
Simulator Lab Experience
Porsche Experience Center | Simulator Lab (Second Floor)
Drop into the Porsche Experience Simulator Lab anytime between 4:30-6:30 PM for a unique simulated driving experience. Visitors can choose from a number of iconic Porsche street and track race cars with highly authentic physics and performance characteristics.
6:00 PM – 8:00 PM
Welcome Reception + Hot Laps Porsche Experience Center | Carrera Café (Second Floor)
Join us for the summit’s official kickoff, where you can network with fellow executives amidst the exhilarating world of Porsche’s legendary engineering. Enjoy food and drinks, and for those seeking an extra thrill, experience the track firsthand with professionally-led hot laps.
Wednesday, October 7th
Wednesday, October 7 | Kimpton Overland Hotel
AI Summit 2026: Executive Program
8:00 AM – 9:00 AM
Breakfast & Networking
9:00 AM – 9:30 AM
Opening Address: The Forces Reshaping Payment Integrity
Dr. Musheer Ahmed opens the summit by examining the converging market forces fundamentally challenging traditional payment integrity models. An aging population is driving exponential claims growth. Sophisticated fraud schemes cost the industry $400 billion annually. Providers are overwhelmed by administrative burden. And trust between payers and providers has eroded to where distrust is the operating norm.
Against this backdrop, payers face mounting pressure to increase savings and reduce costs—demands the current pay-and-chase model cannot meet. Dr. Ahmed will discuss why incremental improvements are no longer sufficient and preview the practitioner insights, case studies, and strategic perspectives attendees will hear throughout the summit as they explore how leading organizations are moving payment integrity further upstream than ever before.
Dr. Musheer Ahmed, PhD
Founder of the AI for PI Community
9:30 AM – 10:15 AM
Opening Keynote Address
Keynote details to be announced.
10:15 – 11:00 AM
One Year Later: Payment Integrity’s Shift from Vision to Reality — Moving Beyond Fragmented, Recovery-Focused Models
A year ago, the conversation around moving payment integrity upstream was largely theoretical. Today, it’s becoming operational reality. Drawing on her experience building a unified platform across payers, providers, and PBMs at Judi Health | Capital Rx, this session explores what it actually takes to move beyond fragmented, recovery-based models and intervene earlier — before cost, friction, and rework are introduced into the system.
For payer executives navigating cost containment strategy in 2026, the session challenges a foundational assumption — that downstream recovery and adversarial processes are the only path. The conversation examines whether a better model is now within reach: one that reduces administrative burden, strengthens provider relationships, and drives meaningful cost avoidance at the source.
Lynn Garbee, SVP
Managed Services, Judi Health | Capital Rx
11:00 AM – 11:15 AM
Break
11:15 – 12:00 PM
Rethinking Provider Engagement: Why One Health Plan Redesigned Its Approach to Provider Education
Provider education programs are meant to improve billing accuracy and reduce payment errors—but too often, they create more friction than improvement. Dr. Priscilla Alfaro shares some provider challenges inside Blue Cross NC’s provider engagement, trends in coding, and education programs that prompted leadership to fundamentally rethink their approach. She’ll discuss the internal pressures driving change, the business case for transformation, and how they’re measuring success differently now—beyond just dollars saved to include provider experience metrics.
Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE, CRC
VP Payment Integrity, Blue Cross NC
12:00 PM – 12:30 PM
Fireside Chat: AI and the Integrity of the Claim—Coding, Fraud, and What’s Changing
As AI becomes more embedded in healthcare workflows, it is beginning to influence not just how claims are reviewed—but how they are created. From AI-assisted coding that can increase billing intensity to AI-enabled fraud and manipulated documentation, the integrity of the claim itself is changing in ways that traditional payment integrity and SIU approaches weren’t designed to address.
In this fireside chat, Kurt Spear shares how these shifts are starting to surface in real investigations—from changes in coding patterns to more sophisticated forms of fraud, including AI-generated or altered records. The discussion will focus on what SIU teams are actually seeing, where existing detection methods are falling short, and how investigative strategies are evolving in response.
Speaker:
Kurt Spear, CFE, CISSP
VP Financial Investigation and Provider Review, Highmark Blue Cross Blue Shield
Moderator:
Jim Brady
VP of Growth, Codoxo
12:30 PM – 1:30 PM
Lunch & Networking
1:30 PM – 2:15 PM
Government Programs in the AI Era: Balancing Innovation, Compliance, and Fiscal Accountability
Government programs face distinct pressures when adopting AI for payment integrity—stringent regulatory oversight, budget constraints, network adequacy concerns, and heightened scrutiny from CMS and state legislators. This panel brings together legal/compliance, government oversight, and Medicaid managed care operational perspectives to explore how government programs navigate AI adoption while managing these competing demands. Panelists will discuss the unique considerations for Medicaid and Medicare programs, how to build internal business cases that satisfy fiscal and political stakeholders, and strategies for implementing innovation without compromising compliance or provider access.
Michael J. Velezis
Vice President and General Counsel, BCBS AL
Sonja Allen-Smith
CFO, DCH GA (Inspector General)
Tom Martin
VP Payment Integrity, AmeriHealth Caritas
2:15 PM – 3:00 PM
Operationalizing AI in Healthcare: Overcoming Barriers and Realizing Value
Across healthcare payers, AI initiatives often stall not because of model performance, but because of breakdowns across people, processes, and technology. Drawing from hands-on work with payer organizations, this session examines the most common barriers leaders encounter when moving AI from pilot to production—organizational readiness, workflow fit, data quality, integrations, governance, and change management. The discussion focuses on practical lessons executives can apply immediately: how successful teams sequence adoption, align stakeholders, set guardrails, and avoid common missteps that erode trust or delay value.
Joanne Galimi
Sr Managing Partner, Market Lead, Gartner
3:00 PM – 3:15 PM
Break
3:15 PM – 4:00 PM
The Road Ahead—Strategic Priorities for Payer Leaders
Drawing from his experience as SVP at Blue Cross Blue Shield of Michigan and now advising multiple health plans through Perspectiv Health, Dr. Aaron Friedkin offers a strategic view of what’s ahead for payment integrity. This session moves beyond individual tactics to examine the broader organizational shifts payer leaders must navigate over the next 12–24 months. Dr. Friedkin will discuss how upstream AI is becoming a competitive differentiator, what separates organizations that successfully operationalize innovation from those that stall in pilot mode, and where executive attention needs to focus—from technology selection to organizational readiness to provider partnership models. With a unique vantage point spanning C-suite decision-making and cross-industry advisory work, he’ll share what he’s seeing work across multiple organizations, where the biggest gaps remain, and what bold moves are required to position payment integrity as a strategic advantage rather than an operational cost center.
4:00 PM – 4:30 PM
The Role of Humans in a World Powered by AI
As AI investment accelerates at an unprecedented pace, healthcare leaders are under increasing pressure to translate that investment into measurable value—while navigating uncertainty around workforce impact, domain expertise, and governance.
This session explores what these shifts mean specifically for payment integrity organizations. From setting realistic expectations for ROI, to preserving the human expertise that underpins accurate decision-making, to defining what responsible AI actually looks like in practice, the discussion will focus on the challenges leaders are actively working through today.
Rather than presenting a fixed playbook, this session offers a candid perspective on where the industry is still evolving—and what organizations should be doing now to ensure AI strengthens, rather than erodes, the long-term effectiveness of their payment integrity programs.
Jenny Karuna
Chief Product Officer, Katch
4:30 PM – 5:00 PM
Closing Remarks: What Happens Next
Dr. Musheer Ahmed closes the summit by reflecting on the day’s conversations and challenging attendees to move from insight to action. He’ll highlight the key themes that emerged—the urgency for upstream intervention, the need to rebuild provider trust, the operational realities of AI adoption, and the competitive advantage that early movers are gaining.
More importantly, he’ll address what needs to happen when attendees return to their organizations: the conversations to have with leadership, the business cases to build, the pilot programs to launch, and the partners to engage. This isn’t the end of a conference—it’s the beginning of a transformation.
Dr. Musheer Ahmed, PhD
Founder of the AI for PI Community
Get in the Driver’s Seat.
Just as elite drivers read the course early and adjust before the turn, today’s top payers use AI and GenAI to get upstream—spotting risk sooner, guiding providers earlier, and avoiding the abrasion and rework that slow everyone down. That’s the advantage you’ll gain at AI Summit 2026.
Get in the
Driver’s Seat.
Just as elite drivers read the course early and adjust before the turn, today’s top payers use AI and GenAI to get upstream—spotting risk sooner, guiding providers earlier, and avoiding the abrasion and rework that slow everyone down. That’s the advantage you’ll gain at AI Summit 2026.
Interested in speaking or sponsoring?
If you are interested in speaking or sponsoring at the 2026 AI Summit, please contact stacia.whelan@codoxo.com.
AI for PI
Community
A collaborative hub for healthcare leaders shaping the future of payment integrity, fraud prevention, cost containment, and provider trust.
AI for PI
Community
A collaborative hub for healthcare leaders shaping the future of payment integrity, fraud prevention, cost containment, and provider trust.