Description
The Executive Office of Health and Human Services (EOHHS) is seeking information from qualified organizations regarding innovative artificial intelligence (AI) tools and technologies to support and strengthen MassHealth's program integrity efforts. The goal is to identify and mitigate fraud, waste, and abuse (FWA) within the MassHealth program. Respondents are invited to provide information on their AI solutions, including their capabilities, experience, and measurable outcomes. The RFI focuses on four key areas: FWA detection, overpayment recovery, managed care program integrity, and claims review and documentation.
• The RFI is seeking information on AI tools and technologies that can detect improper payments, anomalous billing patterns, and emerging fraud schemes.
• Respondents should provide information on their experience with AI and machine learning (ML) in program integrity, including their approach, deployment status, and workflow integration.
• The RFI also seeks information on the pricing structure required to access the AI tool and any quantifiable results or outcomes achieved in detecting FWA.