Review of Health Industry Collaboration Effort Conferences
Summary: For more than 13 years, PCG Software has proudly attended and sponsored the Annual Health Industry Collaboration Effort Conference in Palm Springs, California. This conference is an amazing opportunity for Health Plans, MSOs, and TPAs to meet and learn about compliance, cost containment, AI, and technology innovations that impact not just California but payer organizations around the nation.
What is the HICE Conference?
The Healthcare Internal Controls Conference (HICE) is a national event focused on healthcare compliance, fraud, waste, and abuse (FWA), internal controls, and operational risk management. It brings together health plans, government agencies, auditors, compliance leaders, and technology vendors to discuss regulatory changes, CMS and HHS enforcement priorities, audit strategies, and emerging risks. HICE is known for its practical, enforcement-driven sessions that emphasize real-world compliance challenges rather than theoretical policy discussions.
2025 HICE Conference Review
The 2025 HICE Conference continued its strong emphasis on healthcare compliance, CMS oversight, and internal control frameworks, with a noticeable shift toward discussions around AI, automation, and operational efficiency. While overall attendance was lower compared to prior years, engagement levels were high, particularly during sessions focused on compliance modernization, fraud detection, and technology-enabled auditing. CMS and HHS participation was prominent, with repeated references to tighter compliance expectations heading into 2026. Keynote and breakout sessions reflected growing alignment between regulatory compliance and operational efficiency, reinforcing that automation, AI-driven auditing, and proactive controls are no longer optional for payers, MSOs, and healthcare organizations.
Welcome & Opening Remarks
Speaker: Michael Myers, CEO, HICE
Michael Myers opened the conference by setting the tone for HICE’s 25th anniversary, emphasizing collaboration across compliance, operations, and regulatory bodies. He highlighted the growing pressure on healthcare organizations to modernize internal controls ahead of 2026 regulatory changes.
Healthcare Data Exchange
Panel: APG, HICE, SCHIO, HCAI, LANES, Transform Health
This session explored California’s evolving Healthcare Data Exchange Framework (DxF), focusing on data-sharing challenges, stakeholder alignment, and interoperability gaps. Speakers addressed how AI and automation will reshape claims, prior authorization, and compliance workflows while stressing the need for accurate provider and demographic data.
Annual Legislative & Regulatory Briefing
Speakers: APG, CAHP, Sharp HealthCare, HICE
A high-level regulatory update covering new and pending California legislation impacting Medicare, Medi-Cal, and commercial plans. The briefing focused on how regulatory shifts will affect contracting, compliance, and operational planning heading into 2026.
Office of Health Care Affordability Updates
Speaker: Vishaal Pegany, Deputy Director, HCAI
This session detailed OHCA’s role in enforcing statewide healthcare spending targets and monitoring market consolidation. Attendees gained insight into behavioral health benchmarks, cost impact reviews, and potential new reporting requirements for private equity and MSOs.
DOGE, AI, and Regulatory Accountability (PCG Software)
Speaker: Will Schmidt, Chief Strategy Officer, PCG Software
PCG Software examined how DOGE, AI, and automation are reshaping payer claims and compliance operations. The session focused on CMS and state audit priorities, financial risk of manual processes, and how payers can balance innovation with regulatory compliance.
Delegated Credentialing Compliance
Panel: Evernorth, Blue Shield of CA, UnitedHealthcare
A deep dive into NCQA 2026 credentialing standards and HICE’s shared audit process. Speakers outlined documentation expectations, delegation oversight requirements, and best practices for maintaining credentialing integrity across delegated entities.
Delegation Oversight: Avoiding Compliance Pitfalls
Presented by: ATTAC Consulting Group
This session addressed common delegation oversight failures seen in recent DMHC, DHCS, and CMS audits. Attendees learned lifecycle strategies for overseeing IPAs and MSOs, strengthening CAPs, and aligning compliance with operational teams.
Claims Roundtable: Standardization & 2026 Readiness
Panel: Kern Health Systems, Aetna, Blue Shield of CA
An interactive discussion focused on new 2026 claims payment and interest regulations. The roundtable emphasized standardizing audit preparation through HICE’s Claims Operational Questionnaire and document repository.
Cyberattacks on the Rise: Ransomware in Healthcare
Speaker: Ben Owings, Director, Forvis Mazars
This session examined the increasing threat of ransomware in healthcare, outlining recent attack trends and organizational responsibilities. Attendees learned practical cybersecurity considerations relevant to compliance and operational resilience.
Appointment Availability Compliance
Panel: Blue Shield of CA, UnitedHealthcare, Anthem, Cigna
Focused on DMHC access regulations and PAAS methodology changes, this session covered compliance strategies to improve appointment availability and survey outcomes across commercial and Medi-Cal lines.
Language Assistance Services & AI
Panel: The Cigna Group, Anthem Blue Cross, CQ Fluency
Speakers discussed how executive orders and new regulations are shaping language assistance services. The session explored AI-driven translation tools, remote interpretation, and the continued need for human oversight in sensitive healthcare interactions.
Configurable DOFR: Financial Responsibility Innovation
Presented by: Key Software, Inc.
This session introduced configurable Division of Financial Responsibility (DOFR) technology designed to reduce claims errors and financial leakage. Speakers demonstrated how standardized DOFR rules and data-driven modeling improve claims accuracy.
CMS Final Rule 2026
Panel: UnitedHealthcare, Blue Shield of CA, CommonSpirit Health
A collaborative overview of the 2026 CMS Final Rule and the Shared Health Plan Model of Care training module. The session focused on cross-organizational alignment and standardized implementation strategies.
Appeals & Grievances: Audit Readiness Best Practices
Panel: Anthem Blue Cross, Compliance Leaders
This session reviewed new appeals and grievance regulations, including recent DHCS and CMS guidance. Speakers shared audit readiness strategies and operational best practices to reduce regulatory risk.
Health Equity Accreditation Playbook
Presented by: Evernorth Health Services
An introduction to HICE’s Health Equity Accreditation Playbook, designed to help organizations pursue NCQA Health Equity Accreditation. The session emphasized cross-functional collaboration and documentation strategies.
CMS Keynote: Policy and Practice Update
Speaker: Ashby Wolfe, MD, CMS
CMS provided a forward-looking policy update, addressing national priorities and regulatory direction impacting health plans and providers.
DMHC Keynote: Department of Managed Health Care Update
Speaker: Amanda Levy, DMHC
The DMHC keynote focused on enforcement priorities, regulatory updates, and legislative developments shaping California’s managed care environment.
Revenue Integrity, Compliance & FWA
Presented by: CoventBridge Group
The final session tied together revenue integrity, fraud prevention, analytics, and AI-driven efficiencies. Speakers highlighted how payers are investing heavily in automation to control costs and meet increasing compliance demands.
How much did it cost to attend and/or sponsor?
Attending, sponsoring, and presenting at HICE necessitates a clearly defined financial commitment that varies according to the level of involvement. General attendee registration typically falls within the range of $1,100 to $1,600 per person, influenced by early-bird pricing and membership status. With additional expenses for airfare, hotel accommodations at the conference site, and various incidentals, total attendance costs can often escalate to between $2,500 and $3,500 per participant. Sponsorship and exhibitor packages generally start around $5,000 to $7,500 for basic visibility and can exceed $20,000 to $30,000 for Gold or Platinum sponsorships, which include exhibit space, branding opportunities, and speaking slots.
Presenting as a speaker is usually associated with sponsorships or reserved for invited industry professionals and regulators, demanding significant preparation time, compliance review, and subject-matter expertise rather than a direct speaker fee. Although these expenses are substantial, organizations that approach HICE with a strategic mindset often perceive the investment as well worth it, given the direct access to CMS, DMHC, payer leadership, and compliance decision-makers offered in this concentrated, highly targeted event.
This HICE Conference review will continue each year
As shown throughout the images above, HICE continues to serve as a real-time barometer for where healthcare compliance, operations, and technology are headed. From CMS and DMHC keynote updates to in-depth sessions on AI, DOGE, delegation oversight, and audit readiness, each year reveals not just regulatory direction but how the industry is responding in practice. This article will be updated annually to capture a clear synopsis of each conference—what changed, what stayed the same, who spoke, and which themes mattered most—creating a living record of HICE insights that healthcare leaders can reference year over year as compliance and operational expectations continue to evolve.
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About PCG
For over 30 years, PCG Software Inc. has been a leader in AI-powered medical coding solutions, helping Health Plans, MSOs, IPAs, TPAs, and Health Systems save millions annually by reducing costs, fraud, waste, abuse, and improving claims and compliance department efficiencies. Our innovative software solutions include Virtual Examiner® for Payers, VEWS™ for Payers and Billing Software integrations, and iVECoder® for clinics.
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