Fraud Waste and Abuse System

The Vendor is required to provide to schedule online/virtual strategy discussions from interested Suppliers with experience in fraud, waste, and abuse system.
- Comprehensive system to assist the Agency in combating fraud, waste, and abuse by analyzing and identifying potential findings, leveraging third party data sources, providing case tracking aligned with the case lifecycle, comprehensive financial tracking functionality, and enabling comprehensive reporting.
- The solution shall leverage industry standards and best practices to review Medicaid provider activities, audit claims, identify overpayments, eliminate and recover improper payments, and track cases from referral to collection and recovery.
- The potential system shall be of high quality and have functions that are comprehensive, complete, and provide accuracy in analysis and reporting.
- Expected outcomes would include but are not limited to:
•    Combat fraud and other improper provider activities.
•    Avoid inappropriate Medicaid payments.
•    Recover inappropriate Medicaid overpayments.
•    Coordinate fraud, waste, and abuse activities within the Agency, and with other State and Federal agencies.
•    Ensure the overall integrity of the Medicaid Program by enforcing program requirements.
•    Maintain enrollment of quality providers.
•    Ensure the accuracy of Medicaid payments to providers.