Fraud and Abuse Detection Services
the department seeks program
assistance related to the identification and prevention of fraud, waste, and abuse. These
services should include 1) Data mining, analytics, and tracking tools specific to the
detection of fraud, waste, and abuse, including standard and State specific algorithms; 2)
The provision of on-site subject matter experts with combined experience in the
following areas: fraud and abuse, coding and reimbursement, claims processing,
Medicaid medical and administrative policy, recoveries, and provider relations; 3)
Reporting capabilities that include the ability to generate standard reports that align and
are compliant with CMS and State reporting requirements; 4) Implementation and
tracking of cost avoidance methodologies that include provider education related to the
proper reporting of health care services, and 5) Ability to provide the State of Indiana’s
Medicaid program with a contingency-based Recovery Audit Contractor (RAC) program
that is compliant with Section 6411 of the Patient Protection and Affordable Care Act.
