An overview of the most significant fraud trends and payment integrity technologies and strategies going into 2025.
Kelly Bennett, JD, CFE, AHFI
Kelly Bennett graduated from the University of Tampa and Florida State University College of Law. She has been a member of the Florida Bar since 1997 and is a Certified Fraud Examiner and an Accredited Health Care Fraud Investigator. She has worked at the Florida Agency for Health Care Administration since 2001 and has served in several roles, including as a Senior Attorney within the Medicaid Division of the Office of the General Counsel, the Assistant Bureau Chief for the Bureau of Medicaid Program Integrity, the Agency’s Medicaid
Fraud Liaison, and is currently the Chief of Medicaid Program Integrity, where she has served since July of 2014. She is currently the President for the National Association for Medicaid Program Integrity and is an active participant in training and collaboration initiatives with the National Health Care Antifraud Association.
Dr Priscilla Alfaro, MD, FAAP, CPC, CPMA, COC, CIC, CFE
Dr. Priscilla Alfaro is a seasoned healthcare professional with extensive experience in executive medical management, fraud prevention, and healthcare analytics. A certified medical coder, fraud examiner, and auditor, she has a proven track record of improving healthcare efficiency and preventing fraud, waste, and abuse across various roles and affiliations, including the Texas HHS and Anthem.
Prasanna Ganesan
Machinify
Website: https://www.machinify.com/
Machinify is redefining payment integrity with AI-powered solutions designed to be frictionless, intelligent, and future-ready. Trusted by over 60 health plans, Machinify simplifies the complexity of healthcare claims with a platform that coordinates, validates, and pays claims with precision. Backed by cutting-edge technology and healthcare expertise, Machinify delivers cost savings, operational clarity, and strategic insight—empowering payers to take full control of their payment operations.
Machinify Solutions
Machinify offers a unified platform for payment integrity, combining pre-pay and post-pay solutions to detect, prevent, and resolve improper payments across the claim lifecycle.
- Pre-Pay Adjudication & Accuracy: Automatically identify potential errors or duplications before claims are paid, reducing downstream recovery efforts.
- Post-Pay Analytics & Recovery: Leverage advanced AI to uncover patterns, prioritize audits, and streamline recovery with high accuracy and minimal friction.
- Audit & SIU Support: Equip Special Investigation Units and audit teams with AI-enhanced tools to detect fraud, waste, and abuse faster and more effectively.
- Configurable, Modular Platform: Tailored to integrate into existing workflows with flexibility and speed, enabling rapid value without disruption.
Machinify’s intelligent platform unifies fragmented payment integrity processes, empowering payers to reduce costs, increase efficiency, and improve payment accuracy at scale.
