We’ve seen what happens when teams wait too long to adapt. Plans are left exposed, investigations stall, and fraud continues to drain resources.

This internal quote kicked off a wave of conversations across our team:

“You can’t fight today’s fraud with yesterday’s SIU playbook and expect to protect your plan tomorrow.” – Jeanmarie Loria, CEO, Advize Health

We asked our team to reflect—and what followed was a powerful, unified message: the industry is changing, and we need to change with it.

“There will always be new ways to manipulate, take advantage of, and prey on the vulnerable.”
– Robyn Alvarado, CPC, CPMA

“What worked in the past will not always work due to changing times, fraud schemes, and players. With the attitude of ‘Not on my watch,’ we can and do make a difference every single day.”

Robyn reminds us that fraud doesn’t stop. It adapts. So must we.

“Old schemes are being recycled—and the response isn’t evolving fast enough.”
– Carey Mead, SIU Manager

“There’s too much reliance on stop-gap measures—temporary fixes that don’t address the root problem. Without a multi-pronged approach and real collaboration, bad actors continue unchecked.”

Fraud isn’t just a claim-by-claim issue anymore. It’s systemic. And if we’re not working together across departments—and across plans—it’s only going to grow.

“Update the play to protect the plan.”
– Yarnell McGee, RN, BSN, CPCM, CPC

This one-liner says it all. If you’re not evolving your SIU strategy, you’re already behind. Fraud doesn’t wait, and neither can we.

What About AI? It’s Already Here—And It’s Not Just Helping the Good Guys

“Fraudsters are using AI to generate fake documentation—and many aren’t ready to detect it.”
– Jacob Elkins

Jacob draws from past investigative experience to paint a stark picture of what’s ahead: AI-generated claims, documentation, even identities. Some may be malicious; others may stem from misunderstandings of how AI tools should be used.

Either way, it’s a threat you have to be prepared for.

“AI is a force multiplier—if you use it smartly.”
– Adam Labenow, SIU Investigator

“AI doesn’t give you the full story, but it can supercharge your analysis. You just need to ask more of it—and ask smarter questions.”

Adam reminds us that tech isn’t the enemy—it’s a tool. The real issue? Knowing how to wield it.

The Fraud Landscape Has Changed. Has Your Strategy?

We’re not just watching the industry change—we’re helping shape what comes next. Our team brings real-world experience, investigative grit, and an unwavering commitment to protecting the integrity of healthcare.

And we’re not afraid to say it: The old playbook is dead.

“You can’t fight fraud with yesterday’s playbook. Fraud is dynamic. Interested? Contact us!”
– Dan Olson, Advize Health

If you’re seeing the same schemes hit your plan over and over, if your team is overwhelmed, or if you’re wondering how to keep up—know this:

We’ve got answers. And we’re ready to help. Let’s talk. The future of fraud fighting starts with a new strategy—and it starts now.