This Solicitation opportunity from Georgia was posted on May 12, 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 information from vendors capable of delivering an advanced fraud, waste, and abuse (FWA) detection and prevention solution tailored for the Medicaid program. This initiative targets both the fee-for-service and managed care systems, covering approximately 2.1 million beneficiaries, including PeachCare for Kids®. The goal is to enhance program integrity by identifying fraudulent billing patterns, preventing improper payments through pre- and post-payment reviews, verifying recipient eligibility to avoid duplicate enrollments, and improving pharmacy lock-in monitoring to reduce overutilization. The solution is expected to leverage cutting-edge technologies such as artificial intelligence, cloud-based analytics, and specialized expertise, while integrating with DCH’s internal data warehouse to support rapid investigations and enable efficient referrals to law enforcement. In addition to technology capabilities, DCH is interested in options that provide local staff augmentation to bolster program integrity resources within the Office of Inspector General. This effort reflects a broader commitment to protecting public funds and modernizing the current program integrity functions, which include data analytics, investigations, and pharmacy monitoring. Vendors responding to this solicitation must provide comprehensive market intelligence on their methodologies and service models by the specified deadline, demonstrating how their solutions can effectively support DCH’s Medicaid oversight and safeguard fiscal responsibility across the state of Georgia.
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