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
Brian Dunn
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.
James Vanderberg
James Vanderberg is a Director at HCSC with seven years of experience in the organization’s Special Investigations Department. He currently oversees fraud, waste, and abuse (FWA) operations for government programs.
Prior to joining HCSC, James served with the U.S. Department of Labor, Office of Inspector General, where he retired as the Special Agent in Charge for the Chicago Region. In this role, he led administrative, civil, and criminal investigations involving fraud, waste, and abuse across medical, unemployment, and job training benefits and grants.