Arizona’s Medicaid system to use AI tool to detect fraud beginning in July

The ongoing fight against fraud, waste and abuse within Arizona’s Medicaid system will receive the help of an artificial intelligence tool starting in July.

The Arizona Health Care Cost Containment System (AHCCCS) will adopt an AI-powered “risk scoring” tool that assesses fraud but still requires human oversight on the “highest-risk claims” so as to not absolve expert review, Governor Katie Hobbs announced Thursday.

The preventative strategy, through the Alivia FWA Finder, comes after Hobbs responded to an April 23 letter written by Dr. Mehmet Oz of Centers for Medicare and Medicaid Services for each state governor. The letter “called on all governors to undertake a swift revalidation of high-risk Medicaid providers and submit a broader provider revalidation strategy within 30 days,” according to the announcement.

“Arizona didn’t wait for Washington to call — we’ve been building and deploying the tools to fight Medicaid fraud since I took office,” Hobbs said. “Now, we’re building on this work and launching a first-of-its-kind AI system that will catch fraud before money goes out the door.”

AHCCCS Inspector General Vanessa Templeman said she is looking forward to help Arizona “once again set the national bar for innovation” when it comes to fighting Medicaid fraud.

“In collaboration with state and federal partners, Arizona is excited to be deploying new and upgraded FWA analytics tools, including Alivia FWA Finder, part of the Alivia 360 product suite. I am proud to continue this vital work, and prouder still that Arizona will once again set the national bar for innovation in our fight against those who seek to defraud Medicaid and exploit our most vulnerable populations.”

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