PHOENIX — Artificial intelligence will soon be utilized to review and rank Medicaid claims in Arizona as part of an effort to eliminate fraudulent spending from the government program.
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Later this summer, the Arizona Health Care Cost Containment System intends to launch an AI-driven tool meant to detect and flag suspicious Medicaid claims before the state allocates payment.
The technology will assess claims submitted to AHCCCS and refer claims rated as being “high-risk” for fraud to human review, the governor’s office said.
“AI-driven risk scoring is paired with expert clinical oversight, with automated tools informing rather than replacing human judgment,” Hobbs recently wrote in a letter to the Centers for Medicare and Medicaid Services. “This reflects Arizona’s commitment to catching problems before money goes out the door, rather than relying on post-payment recovery, which is costlier, less effective, and yields only a fraction of improper payments.”
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The AHCCCS agency oversees multiple programs that provide health care services to low-income residents throughout the Grand Canyon State.
AHCCCS was at the center of a major scandal a few years ago after state officials suspended several behavioral health care providers for suspicions of fraud. Several indictments were filed and law enforcement officials estimated that up to $2 billion had been allegedly swindled from AHCCCS.
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