Concerning waste, fraud, and abuse prevention, detection, and recovery to improve program integrity for medical services programs.
Summary
Requires the Health Care Authority (HCA) to issue a request for information (RFI) about implementing new program integrity provisions for various low-income medical programs.
Requires the RFI to request input on predictive modeling and analytics technologies to find patterns that represent high risks of fraudulent activity and prevent payment of suspect claims until the claims have been verified as valid.
Requires the RFI to seek input on provider and enrollee data verification technologies.
Requires the RFI to request input on investigation services that combine retrospective and prospective analyses of waste, fraud, and abuse.
Encourages the HCA to issue a request for proposals to implement these program integrity provisions under specified conditions.
Requires contracts for these services to use a shared-savings model where the state's only direct cost is providing a portion of the actual savings to the contractor.
From the Engrossed Substitute House Bill Report (ESHB 2571), written by the Legislature's nonpartisan staff. Read the full report ↗