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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>54400</law_id><section_number>32.1-319.1</section_number><catch_line>Department to establish pilot program to use data analytics to mitigate risk of improper payments</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>2.2-4348</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="32.1">Health</unit><unit label="chapter" level="2" order_by="1" identifier="9">Regulation of Medical Assistance</unit><unit label="article" level="3" order_by="1" identifier="1">In General</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> The <span class="dictionary">Department</span> shall conduct a pilot program to develop and implement means to mitigate the risk of improper payments to providers of services furnished under the state plan for medical assistance and all applicable <span class="dictionary">waivers</span>. The pilot program shall include the use of predictive modeling, provider profiling, trend analysis, and other analytics to identify providers with a high likelihood of <span class="dictionary">fraud</span>, abuse, or error and prevent payments on potentially fraudulent or erroneous claims from being made until such claims have been validated. <a id="paragraph-199699" class="section-permalink" href="https://vacode.org/32.1-319.1/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> The <span class="dictionary">Department</span> may enter into a <span class="dictionary">contract</span> or agreement with a vendor for the operation of the pilot program to mitigate the risk of improper payments to providers of services furnished under the state plan for medical assistance and all applicable <span class="dictionary">waivers</span> required by this section. However, selection of a vendor shall be dependent on the demonstration of a proof of concept, prior to entering into a <span class="dictionary">contract</span> or agreement. <a id="paragraph-199700" class="section-permalink" href="https://vacode.org/32.1-319.1/#B"><i class="fa fa-link"/></a></p></section></text><history>2017, c. 750; 2019, c. 422.</history><metadata></metadata></law>
