A New York healthtech startup teaching AI to forensically audit hospital bills - with a clinician checking every call.
FOUNDED 2020 · NEW YORK, NY · $73M+ RAISED
Every year, the American healthcare system loses an estimated $570 billion to improper payments and administrative waste. Much of it hides in plain sight: a hospital claim for a multi-day stay, a stack of medical records thousands of pages deep, and a human auditor with only so many hours to reconcile the two. Alaffia Health was built to close that gap.
Founded in 2020 by siblings TJ Ademiluyi and Adun Akanni, Alaffia is an AI-powered payment integrity platform for health insurers. Its software reads the complete patient medical record, compares it against the submitted claim, and flags charges that do not add up - overpayments, coding errors, waste, fraud, and abuse. What once took weeks now takes days.
The twist is what Alaffia refuses to remove: the human. Rather than replacing clinicians with a black box, the company pairs agentic AI with expert reviewers who verify every finding. The result, the company argues, is not just faster review but a more defensible one - the kind that survives a provider dispute, an appeal, or a regulator's questions.
That combination - speed plus explainability - is the whole pitch. In an industry where automation is easy to sell and hard to trust, Alaffia is betting the trust is the product.
Health plans face rising medical costs, tighter regulatory scrutiny, and pressure to keep coverage affordable - all at once. Reviewing high-cost facility claims by hand is slow, inconsistent, and expensive. Generic automation tends to break against the complex, diverse rule sets each payer runs, and it struggles to explain its own decisions.
Alaffia sells to regional and national health plans and cost containment firms. Its users are the people doing the work: clinicians, medical coders, and the payment integrity, utilization management, special investigations, and appeals teams who live inside the claims lifecycle every day.
“Healthcare doesn't need more automation that no one can explain - it needs AI that clinicians, operators, and regulators can trust.” — Adun Akanni, Co-Founder & COO, Alaffia Health
An integrated claim review SaaS platform that lets health plans ingest, review, and process claims - the shared workspace for payment integrity, utilization management, special investigations, and appeals.
A generative AI assistant built for payers that automates large medical-record reviews, clinical policy assessment, and claim adjudication - powering facility reviews up to 20x faster.
AI agents read the full medical record, extract structured clinical facts with 97%+ accuracy, and compare charges to the record - always paired with a human clinician's judgment.
The payment integrity market is not empty. Legacy and emerging vendors - names like Cotiviti, Optum, Zelis, EXL, Lyric, Machinify, and ClarisHealth - all promise to help payers recover improper payments. Alaffia's wager is that most of them lean on rules, retrospective recovery, or automation that cannot show its work.
Alaffia's differentiation rests on three ideas. First, agentic AI that reads the entire medical record rather than pattern-matching on claim codes alone. Second, human-in-the-loop review, so every flag is validated by a clinician and can be defended in an appeal. Third, an outcomes-aligned business model: Alaffia largely gets paid by retaining a share of the savings it produces, so it only wins when the client does.
That last point doubles as market positioning. Investor Todd Cozzens of Transformation Capital calls payment integrity “one of the most untapped opportunities in healthcare,” precisely because payers are hard to build for. Alaffia leaned into that difficulty rather than around it - the complexity is the moat.
B2B SaaS with an outcomes-aligned component - Alaffia primarily earns by keeping a percentage of the savings it generates for clients.
Deep bench of clinicians and medical coders working alongside AI engineers, with HITRUST and HIPAA-aligned security for handling sensitive records.
Positioned in the pre-payment integrity segment - stopping improper spend before it goes out the door, not just clawing it back later.
Siblings TJ Ademiluyi and Adun Akanni launch Alaffia in New York to bring modern technology to medical claims review.
The integrated claim review SaaS platform begins serving payment integrity, utilization management, and appeals teams.
Alaffia raises $10M and launches Ask Autodor, its generative AI assistant for healthcare payers.
Transformation Capital leads a $55M round; Everest Group names Alaffia a Major Contender in pre-payment integrity.
| Round | Amount | Date | Lead / Investors |
|---|---|---|---|
| Series B | $55,000,000 | Feb 2026 | Transformation Capital (lead), FirstMark Capital, Tau Ventures, Twine Ventures |
| Earlier raise | $10,000,000 | 2024 | FirstMark Capital, Tau Ventures |
| Total | $73M+ | — | Board addition: Todd Cozzens, Transformation Capital |
Started his career in finance at Goldman Sachs before returning to healthcare. Grew up around a family medical-billing business - the domain knowledge that seeded Alaffia. Leads company strategy and vision.
TJ's sibling and operating partner, focused on scaling the platform and its clinical operations. The voice behind Alaffia's insistence on explainable, trustworthy AI.
“Payment integrity is one of the most untapped opportunities in healthcare, in part because payers are harder to build for due to their complex and diverse rule sets.” — Todd Cozzens, Managing Partner, Transformation Capital
It provides an AI-powered payment integrity platform that helps health insurers detect and stop waste, fraud, and abuse in medical claims - reviewing full patient medical records against submitted claims, with expert clinicians validating findings.
It was founded in 2020 by siblings TJ Ademiluyi (CEO) and Adun Akanni (COO), who grew up around a family medical-billing business.
More than $73M total, including a $55M Series B in February 2026 led by Transformation Capital with FirstMark Capital, Tau Ventures, and Twine Ventures.
Autodor is Alaffia's integrated claim review SaaS platform. Ask Autodor is its generative AI assistant, which lets clinicians and coders review complex facility claims up to 20x faster.
Through a B2B SaaS model with an outcomes-aligned component - it primarily earns by retaining a share of the savings it generates for health-plan clients.