By admin 
TUCSON, Ariz. (13 News) – Arizona Gov. Katie Hobbs on Monday, May 18, announced a new artificial intelligence tool to stop Medicaid fraud and abuse before claims are paid.
Read more University of Arizona program helps students with disabilities gain job skills
The announcement comes following what she called the biggest fraud scandal in the state’s history.
It’s a big deal in Pima County, where nearly one-third of residents are enrolled in AHCCCS, the state’s Medicaid program.
“These fraudsters lived lavishly, buying luxury cars and multi-million-dollar homes halfway around the world while the people they were supposed to care for endured unimaginable suffering, and in some cases, lost their lives,” Hobbs said.
Since 2023, the state has issued 140 indictments and cut off 364 providers in relation to Medicaid fraud. Hobbs said the number of cases has decreased greatly in the past three years.
“This decline isn’t because we’ve slowed our efforts; it’s because the criminals have heard our message loud and clear – Arizona has zero tolerance for waste and fraud and abuse,” Hobbs said.
AHCCCS is rolling out an AI tool that will conduct prepayment reviews.
“Once we find fraud, we can respond to it and then stop it from continuing to occur by stopping the potential exposure, the additional risks, things along those lines,” said Vanessa Templeman, AHCCCS inspector general.
Templeman said the tool is not completely computer-based and includes a human element.
Read more Republican lawmakers say Arizona not doing enough to combat Medicaid fraud
“There’s a human in the loop purposefully to see that pattern come through, acknowledge it’s correct, dial it in or change it, or even acknowledge that we do have one edit, we do have one pattern, maybe there’s another one that we need to add in and take a further look at,” Templeman said.
The human element also ensures providers aren’t being blamed for fraud when they’ve just made a mistake, Templeman said. Entities that might not be billing properly will be offered education to ensure those mistakes are not made again.
Hobbs said the program will work with Arizona’s tribal nation leaders, as the fraud has disproportionately impacted Indigenous people.
“We’re gonna do everything we can to stop it from happening in the future and to bring justice to folks who were harmed, who lost their lives, who lost their loved ones,” Hobbs said.
Templeman said the AI tool has been in the works for well over a year and is expected to be completely up and running by July.
Are you streaming 13 News?
Watch a free live stream of Tucson Now and 13 News at TucsonNow.Live.
Be sure to download the free Tucson Now app, which you can find on Apple and Google.
If you are using a desktop computer, you can use your mobile device to scan the QR code below.
Read more Tucson staycation deals offer Memorial Day alternatives as gas prices climb
You can submit your breaking news or weather images here.