As health plans continue to evolve their strategies around medical cost containment, the distinction between payment integrity and fraud, waste, and abuse is becoming increasingly nuanced. This session explores the “gray zone” where wasteful or abusive billing practices don’t clearly qualify as fraud, but still pose significant financial and ethical risks.
- How payment integrity and SIU teams can effectively collaborate
- Where the hand-off should occur between routine overpayment detection and deeper investigation
- Real-world examples where waste tipped into abuse, and how it was handled
- How health plans can build workflows that enable earlier intervention before issues escalate
- The operational and cultural gaps between PI and SIU and how to bridge them
Matt Perryman
Matt leads Alivia’s advanced analytics, data science, and platform development for fraud, waste, and abuse (FWA) detection—validated through payment integrity edits, audits, and data mining. With expertise in healthcare analytics and risk modeling, he oversees AI-powered solutions that help Medicaid, Medicare, and commercial payers prevent improper payments and uncover emerging fraud schemes.
Before assuming this role, Matt built a strong reputation at Alivia as a customer-facing data scientist, helping technical and non-technical users alike apply analytics to drive measurable results. He is a regular speaker at healthcare FWA conferences, including NHCAA and NAMPI, where he presents pre- and post-payment analytic strategies alongside health plan leaders. He was valedictorian of his graduating class from Boston College with degrees in biochemistry and philosophy.
Scott Hirschbrunner
Scott brings a wealth of experience, with a 26-year background in PI leadership at CMS, Optum, and Blue Cross & Blue Shield of Kansas City. He currently is the Director of Payment Integrity at Blue Cross Blue Shield of Nebraska. His functional areas of responsibility include SIU, Recovery, Bill-Audit, Claim Editing, COB, W/C, Subrogation, DRG Audit, Data Mining and Credit Balance Recovery. Scott’s goals are strengthening management of PI vendor performance and contracts, seeking opportunities for generating revenue and setting of targets using national benchmark data. He holds a Bachelor of Science in Accounting with a minor in Management and Communications and is well-versed in both commercial and government lines of business. Scott is married for 16 years with two boys and two girls. He enjoys being outdoors, doing yard work, taking walks, coaching girls’ softball, giving blood, and volunteering.