Georgia Supplier Systems #DCH0000142

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

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 its Medicaid program, covering approximately 2.1 million members. - Government Buyer: - Georgia Department of Community Health (DCH), Office of Inspector General (OIG), Procurement Services - Products/Services Requested: - Comprehensive FWA detection and prevention software solution for Medicaid - Should leverage artificial intelligence (AI) and cloud-based data analytics - Must support prepayment and post-payment review functions - Capabilities for verifying recipient residency and eligibility - Pharmacy lock-in monitoring and analysis of aberrant provider billing trends - Real-time access and integration with DCH’s internal data warehouse - Staff augmentation services to support evolving program integrity needs - Notable Requirements: - Solution must enhance program integrity for both fee-for-service and managed care Medicaid delivery systems - Should provide advanced analytics and subject matter expertise - Must be able to interface with DCH’s data systems and support local staff - Vendors are asked to provide information on technology, implementation, pricing, security, and federal compliance - No specific OEMs or vendors are named in the RFI - This is a Request for Information (RFI) for planning and market research only; no purchase quantities or part numbers are specified except for a single Medicaid software monitoring solution (quantity: 1)

Description

The Georgia Department of Community Health (DCH) is issuing this Request for Information (RFI) to identify qualified vendors capable of providing a comprehensive fraud, waste, and abuse (FWA) 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 procurement aims to strengthen program integrity across both fee-for-service and managed care delivery systems, including anticipated managed care expansion 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.