Georgia Supplier Systems #DCH0000143

Georgia DCH Seeks AI-Driven Medicaid Fraud, Waste, and Abuse Detection Solutions

The Georgia Department of Community Health (DCH) is seeking information from the market on advanced solutions to detect and prevent fraud, waste, and abuse (FWA) in the state's Medicaid and PeachCare for Kids programs. - Government Buyer: - Georgia Department of Community Health (DCH), Office of Inspector General - Products/Services Requested: - Comprehensive FWA detection and prevention solution for Medicaid - Must leverage artificial intelligence and cloud-based data analytics - Should support both prepayment and post-payment review of claims - Capabilities to detect aberrant provider billing trends and FWA patterns - Residency and eligibility verification to prevent duplicate enrollment - Pharmacy lock-in monitoring to prevent overutilization - Real-time access to DCH’s internal data warehouse for investigations - Data analytics to identify improper payments and support cost avoidance - Staff augmentation services - Local staff to support program integrity as Medicaid delivery models evolve - Unique/Notable Requirements: - Solution must address both fee-for-service and managed care environments - Should support approximately 2.1 million Medicaid members - Must provide detailed feedback on technology, implementation, pricing, security, and federal compliance - No specific OEMs or vendors named; this is a market research RFI, not a formal solicitation - Place of Performance: - Statewide across Georgia, with focus on DCH offices in Atlanta and Cordele

Description

The Georgia Department of Community Health (DCH) is issuing a Request for Information (RFI) to identify qualified vendors capable of providing 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 aberrant provider billing trends, support prepayment and post-payment reviews, verify recipient residency and eligibility, enhance pharmacy lock-in monitoring, and provide real-time access to DCH's internal data warehouse. The solution may also include local staff augmentation to maintain program integrity capacity as Medicaid delivery models evolve, including the expansion of managed care to blind and disabled populations by 2028. This RFI is for planning and market research purposes only and does not constitute a solicitation or commitment to procure services.

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