                                 CODE OF VIRGINIA

DEPARTMENT TO ESTABLISH PILOT PROGRAM TO USE DATA ANALYTICS TO MITIGATE RISK OF
IMPROPER PAYMENTS (§ 32.1-319.1)

A. The Department 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 waivers. 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 fraud, abuse, or error and prevent payments on potentially fraudulent or
erroneous claims from being made until such claims have been validated.

B. The Department may enter into a contract 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 waivers 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 contract or agreement.

HISTORY: 2017, c. 750; 2019, c. 422.