Georgia Procurement Registry #41900-DCH0000143

Georgia DCH Seeks Information on Medicaid Fraud, Waste, and Abuse Detection Solution

The Georgia Department of Community Health (DCH), Office of Inspector General, is seeking information from vendors about solutions to detect and prevent Medicaid fraud, waste, and abuse (FWA). - Government Buyer: - Georgia Department of Community Health, Office of Inspector General - OEMs and Vendors: - No specific OEMs or vendors are named in the request - Products/Services Requested: - Comprehensive FWA detection and prevention solution for Medicaid - Should leverage artificial intelligence and cloud-based data analytics - Must support detection of aberrant provider billing trends - Should enable both prepayment and post-payment review functions - Must verify recipient residency and eligibility - Should enhance pharmacy lock-in monitoring - Must provide real-time access to DCH’s internal data warehouse for investigations - May include local staff augmentation to support program integrity - Unique or Notable Requirements: - Advanced technology-driven capabilities are required - Solution must address both fee-for-service and managed care Medicaid systems - Staff augmentation may be included to ensure sufficient program integrity capacity - No part numbers or purchase quantities specified; this is a request for information to gather market intelligence

Description

The Georgia Department of Community Health (DCH) is issuing a Request for Information (RFI) to identify 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 monitoring, and provide real-time data access for investigations. The solution may also include local staff augmentation to maintain program integrity capacity. This RFI aims to gather market intelligence on technologies and service models to strengthen Medicaid program integrity across fee-for-service and managed care systems.

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