AI is transforming healthcare, but how can organizations harness its benefits while staying ahead of increasingly sophisticated threats?

In this episode, Shirley Macbeth sits down with Kurt Spear, Vice President of Financial Investigation and Provider Review at Highmark, to explore how AI is improving payment integrity, fraud detection, and operational efficiency. Kurt also shares how his teams are applying AI to identify billing errors, review complex medical records, and uncover emerging fraud schemes.

You will hear why practical use cases matter, how data quality and governance influence AI success, and why human judgment remains essential as healthcare organizations scale AI across critical workflows.

Key takeaways:

• Apply AI to high-impact review workflows where speed and accuracy matter most
• Build AI initiatives around trusted data, governance, and cross-functional input
• Use human expertise to validate AI outputs and stay ahead of emerging fraud risks

Highlights:

(00:00) Introducing Kurt Spear

(01:55) Kurt’s role across fraud investigations and payment integrity

(03:04) The healthcare cost pressures impacting payment integrity

(04:29) Where AI is showing up across the healthcare system

(05:45) Using AI to review records, find errors, and detect fraud

(10:44) How to get started with practical AI use cases

(13:06) Why data quality still matters

(15:20) Bringing teams along in AI adoption

(19:12) Why human judgment is critical to AI decisions

(21:00) Staying ahead of AI-enabled fraud

(22:51) Why AI is now a business imperative

Resources:

Kurt's LinkedIn: https://www.linkedin.com/in/kurt-spear-cfe-cissp-8654842a/

Highmark website: https://www.highmark.com/

Highmark LinkedIn: https://www.linkedin.com/company/highmark/

Shirley's LinkedIn: https://www.linkedin.com/in/shirleymacbeth/