Prevention is getting earlier. Detection is getting smarter. Investigation still determines what’s real.
As #NAMPI2026 comes to a close in Portland, one thing is clear: Medicaid program integrity is continuing to move upstream.
Prepayment review.
Connected data.
Advanced analytics.
AI-informed detection.
Stronger prevention strategies.
All of these tools can help identify potential risk earlier—and that is an important step forward.
But earlier detection does not eliminate the need for investigation.
A flag still has to be validated.
A pattern has to be understood.
Documentation has to be examined.
Connections have to be followed.
Evidence has to support the conclusion.
And ultimately, someone has to determine whether what looks unusual is an error, an emerging scheme, or intentional misconduct.
The strongest program integrity models will not choose between technology and investigative expertise. They will connect them.
That is one of the conversations we’re leaving #NAMPI2026 thinking about most—and one we look forward to continuing well beyond Portland.
Thank you to NAMPI and the Medicaid program integrity community for the conversations, collaboration and shared commitment to protecting critical programs.
#NAMPI #Medicaid #ProgramIntegrity #FWA #FraudWasteAndAbuse #HealthcareFraud #Investigations #SIU #PaymentIntegrity #FraudPrevention #HealthcareAI
