| Page 31 | Kisaco Research

From Fragmented Data to Shared Intelligence

Key discussion points:
- How state agencies and managed care organisations can build collaborative infrastructure to facilitate information exchange among MCO SIUs, oversight bodies, actuaries, and auditors
- Impact of shared information exchange on anomaly detection, high risk providers, and overpayment management
- How improved collaboration impacted managed care rate setting

Author:

Brian Dunn

Inspector General

Illinois Department of Healthcare and Family Services

Brian Dunn serves as the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state’s $37 billion Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago’s Office of Inspector General. Before leading government oversight work, Brian’s legal career included serving as the General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.

Read more about From Fragmented Data to Shared Intelligence

From Fragmented Data to Shared Intelligence

Read more about From Fragmented Data to Shared Intelligence

From Fragmented Data to Shared Intelligence

Key discussion points:
- How state agencies and managed care organisations can build collaborative infrastructure to facilitate information exchange among MCO SIUs, oversight bodies, actuaries, and auditors
- Impact of shared information exchange on anomaly detection, high risk providers, and overpayment management
- How improved collaboration impacted managed care rate setting

Author:

Brian Dunn

Inspector General

Illinois Department of Healthcare and Family Services

Brian Dunn serves as the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state’s $37 billion Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago’s Office of Inspector General. Before leading government oversight work, Brian’s legal career included serving as the General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.

Read more about From Fragmented Data to Shared Intelligence

Leveraging AI to Balance Upcoding Risk & Relationships

As AI adoption accelerates across clinical documentation, coding, and billing workflows, health plans are facing new challenges balancing claims accuracy, operational efficiency, and provider collaboration. Join Alaffia for a candid discussion on how AI-driven claims intelligence can help plans address emerging upcoding risk, improve oversight in high-impact areas, and move closer to a shared source of truth across the claims lifecycle.

Where health plans are seeing the most volatility in complex, high-dollar claims such as sepsis
How plans are adapting review and oversight models in an AI-enabled environment while reducing provider abrasion
How clinician-informed, agentic AI can support scalable payment integrity and workflow automation across pre-pay and post-pay settings
How payers can use AI to improve coding accuracy, strengthen payer-provider alignment, and support defensible outcomes

In partnership with Alaffia Health

Author:

Andrew Li

Director of Product

Alaffia

Author:

Oyinade Famuyiwa, PharmD

Vice President, Payment Integrity Operations

Alaffia Health

Oyinade Famuyiwa is a clinician and healthcare operator with expertise spanning patient care, claims management, and payment integrity. She earned her Doctor of Pharmacy from the University of Maryland and began her career providing direct patient care in various clinical practice settings, gaining firsthand insight into the challenges of care delivery.

She later advanced into leadership at Aegis Health Services, a healthcare startup, where she served as Clinical Pharmacist and Regional Manager of Clinical Services, overseeing clinical program delivery and compliance, documentation quality, and claims accuracy. This experience sharpened her ability to connect frontline care with the operational and financial integrity of health systems.

As a founding team member of Alaffia Health, Oyinade has been instrumental in shaping the company’s AI-powered payment integrity platform and service model. She brings critical provider insight to audit design, grounding it in clinical practice, billing accuracy, and regulatory standards. By leveraging her expertise in claims management and compliance, alongside a deep understanding of documentation and coding vulnerabilities, she fuels Alaffia’s ability to combat fraud, waste, and abuse at scale.

Today, as Vice President of Payment Integrity Operations, Oyinade leads the company’s claim review strategy and execution, delivering defensible, scalable solutions that enhance payer performance, ensure regulatory compliance, and generate tens of millions of dollars in savings for health plan clients nationwide.