Georgia Procurement Registry #41900-DCH0000142

Georgia Medicaid seeks AI-powered fraud, waste, and abuse detection solution

The Georgia Department of Community Health (DCH) is seeking a modern solution to enhance fraud, waste, and abuse (FWA) detection in its Medicaid program. - Buyer: Georgia Department of Community Health (DCH) - No specific OEMs or vendors are named in the notice - Products/Services Requested: - Comprehensive FWA detection and prevention solution for Medicaid - Must leverage artificial intelligence and cloud-based data analytics - Should support detection of aberrant provider billing, prepayment and post-payment reviews, recipient residency and eligibility verification, and pharmacy lock-in monitoring - Real-time access to DCH’s internal data warehouse for investigations - Staff augmentation services to support program integrity functions - Unique/Notable Requirements: - Solution must address both fee-for-service and managed care delivery systems - Emphasis on modernization and augmentation of current program integrity functions - Local staff augmentation may be required to ensure sufficient capacity as the program evolves

Description

The Georgia Department of Community Health (DCH) is seeking information from qualified vendors for a comprehensive fraud, waste, and abuse detection and prevention solution for the Georgia Medicaid program. The solution should leverage artificial intelligence, cloud-based data analytics, and subject matter expertise to detect fraudulent billing, support payment reviews, verify recipient eligibility, enhance pharmacy lock-in monitoring, and provide real-time data access for investigations. The procurement aims to augment and modernize current program integrity functions across fee-for-service and managed care delivery systems. A local staff augmentation component may also be included to maintain program integrity capacity.

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