This Solicitation opportunity from Georgia was posted on May 11, 2026. The submission period has ended. Browse the details below for market research, or find similar active opportunities.
OIG Medicaid Fraud, Waste, and Abuse
Contract Overview
Solicitation details, issuing organization, response deadlines, documents, and interested companies for this government contract opportunity.
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AI Contract Overview
The Georgia Department of Community Health (DCH) is seeking qualified vendors to provide an advanced fraud, waste, and abuse (FWA) detection and prevention system for its Medicaid program. This initiative aims to enhance program integrity across both fee-for-service and managed care systems covering over two million individuals, including participants in the PeachCare for Kids® program. The department currently relies on its Office of Inspector General’s program integrity units but is looking to modernize and expand these efforts with a solution that incorporates cutting-edge technologies such as artificial intelligence and cloud-based analytics. The sought-after solution should be capable of identifying unusual billing patterns, supporting both prepayment and post-payment reviews for improper payment recovery, verifying recipient eligibility, and improving pharmacy lock-in monitoring to prevent medication overuse. Additionally, it must provide real-time integration with DCH’s data warehouse to enable rapid investigations and coordination with law enforcement when necessary. There is also potential for local staff augmentation to support the department's operational needs. The solicitation, identified as 41900-DCH0000142, was posted with a response deadline of May 25, 2026, and interested parties are encouraged to contact Timothy Anderson for more information.
General Info
Agency
NAICS
Place of Performance
GA, USASet-Aside
Timeline
Submission Closed
Organization & Contact Information
Full Description
DCH administers Medicaid benefits to approximately 1.5 million managed care members and 591,000 fee-for-service members across Georgia, in addition to overseeing the PeachCare for Kids® program. As stewards of public funds, DCH is committed to protecting the fiscal integrity of these programs by detecting and deterring fraudulent, wasteful, and abusive billing practices among providers and recipients alike. The Office of Inspector General (OIG) currently performs program integrity functions through its Intake and Data Analytics, Review and Investigations, and Pharmacy Lock-In sub-units; however, DCH seeks to augment and modernize these capabilities through the acquisition of an advanced, technology-driven solution.
Specifically, DCH intends to procure a solution that leverages artificial intelligence, cloud-based data analytics, and subject matter expertise to: (1) detect aberrant provider billing trends and patterns of fraud, waste, and abuse in both FFS and managed care; (2) support prepayment and post-payment review functions to identify and recover improper payments; (3) verify recipient residency and eligibility to prevent duplicate enrollment across states; (4) enhance pharmacy lock-in monitoring to prevent overutilization; and (5) provide real-time access to DCH¿s internal data warehouse for rapid investigation and potential referral to law enforcement. The solution may also include a local staff augmentation component to ensure DCH maintains sufficient program integrity capacity as its Medicai