{"id":504,"date":"2026-05-19T10:34:14","date_gmt":"2026-05-19T10:34:14","guid":{"rendered":"https:\/\/tucsonmovingreport.com\/?p=504"},"modified":"2026-05-19T10:34:14","modified_gmt":"2026-05-19T10:34:14","slug":"arizona-rolls-out-ai-tool-to-prevent-medicaid-fraud","status":"publish","type":"post","link":"https:\/\/tucsonmovingreport.com\/?p=504","title":{"rendered":"Arizona rolls out AI tool to prevent Medicaid fraud"},"content":{"rendered":"
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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.<\/p>\n

Read more University of Arizona program helps students with disabilities gain job skills<\/a><\/p>\n

The announcement comes following what she called the biggest fraud scandal in the state\u2019s history.<\/p>\n

It\u2019s a big deal in Pima County, where nearly one-third of residents are enrolled in AHCCCS, the state\u2019s Medicaid program.<\/p>\n

\u201cThese 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,\u201d Hobbs said.<\/p>\n

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.<\/p>\n

\u201cThis decline isn\u2019t because we\u2019ve slowed our efforts; it\u2019s because the criminals have heard our message loud and clear \u2013 Arizona has zero tolerance for waste and fraud and abuse,\u201d Hobbs said.<\/p>\n

AHCCCS is rolling out an AI tool that will conduct prepayment reviews.<\/p>\n

\u201cOnce 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,\u201d said Vanessa Templeman, AHCCCS inspector general.<\/p>\n

Templeman said the tool is not completely computer-based and includes a human element.<\/p>\n

Read more Republican lawmakers say Arizona not doing enough to combat Medicaid fraud<\/a><\/p>\n

\u201cThere\u2019s a human in the loop purposefully to see that pattern come through, acknowledge it\u2019s correct, dial it in or change it, or even acknowledge that we do have one edit, we do have one pattern, maybe there\u2019s another one that we need to add in and take a further look at,\u201d Templeman said.<\/p>\n

The human element also ensures providers aren\u2019t being blamed for fraud when they\u2019ve 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.<\/p>\n

Hobbs said the program will work with Arizona\u2019s tribal nation leaders, as the fraud has disproportionately impacted Indigenous people.<\/p>\n

\u201cWe\u2019re 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,\u201d Hobbs said.<\/p>\n

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.<\/p>\n

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Read more Tucson staycation deals offer Memorial Day alternatives as gas prices climb<\/a><\/p>\n

You can submit your breaking news or weather images here<\/b><\/u><\/i>.<\/b><\/u><\/i><\/p>\n<\/section>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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