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.
Linde Winton
Linde Winton is the Senior Director of Operations for Provider Partners Health Plan and a healthcare executive with nearly four decades of experience in managed care, Medicare Advantage, compliance, claims administration, and payment integrity. Throughout her career, she has led operational, compliance, quality assurance, audit, and Special Investigation Unit (SIU) programs for health plans, third-party administrators, and healthcare technology organizations.
Linde has extensive expertise in payment integrity, fraud, waste and abuse prevention, regulatory compliance, claims operations, vendor oversight, and healthcare analytics. She has developed and implemented enterprise-wide audit and investigation programs, directed complex regulatory initiatives, overseen large-scale operational improvements, and partnered with organizations to strengthen payment accuracy while maintaining compliance with evolving federal and state requirements.
Recognized for her ability to bridge the gap between operational execution and regulatory oversight, Linde brings a practical, real-world perspective to healthcare payment integrity. Her work has focused on identifying emerging risks, improving claims accuracy, leveraging data analytics to uncover hidden issues, and implementing sustainable solutions that drive measurable results. As a frequent collaborator across operations, compliance, and payment integrity teams, she is passionate about helping organizations navigate today's increasingly complex healthcare environment while protecting the integrity of healthcare payments.
