RFI 1406 - Program Integrity Audit.doc

BRAD LITTLE - Governor

JULIET CHARRON - Director

Staci Phelan, Administrator

Division of Management Services

Bureau of Compliance

450 West State Street, 9th Floor

PO Box 83720

Boise, Idaho 83720-0036

Phone 208-334-5578

FAX 208-334-5694

Issue date:

08/11/2026 Closing date:

08/31/2026

Subject:

Request for Information (RFI) for Public Benefit Program Integrity The Idaho Department of Health and Welfare is requesting information concerning the furnishing of services for Program Integrity functions across multiple public benefit programs. Information obtained from the responses to this RFI may be used to refine the requirements for a formal Request for Proposal (RFP) which may be released at a later date, assist us in projecting a budget for acquiring the services, and also to identify potential vendors who may be interested in providing a competitive proposal.

It is important to note that this is a request for information only, not a solicitation. No award will be made based upon the information received.

I. Introduction and Background

The Department is issuing this Request for Information (RFI) to gather details from qualified vendors about available solutions, technologies, and service models that support enterprise-wide detection, identification, prioritization, and investigation of Fraud, Waste, and Abuse (FWA) across public benefit programs to include but not limited to the Supplemental Nutrition Assistance Program (SNAP); Temporary Assistance for Needy Families (TANF); Idaho Child Care Program (ICCP); and Medicaid beneficiary FWA.

This RFI excludes FWA detection and investigations tied to Medicaid providers as this function is carried out by the Department’s Medicaid Program Integrity Unit (MPIU) which has existing resources.

The Department is specifically interested in contingency‑based payment structures, where the vendor retains an agreed‑upon percentage of verified recoveries or cost savings, resulting in no upfront cost to the Department.

Recent federal actions highlight the urgency of enhancing proactive fraud detection and program integrity across public benefit programs. In January 2026, the U.S. Department of Health and Human Services (HHS) froze childcare and family assistance grants in five (5) states due to fraud concerns, signaling increased scrutiny across all federally funded programs and resulting in heightened expectations for compliance and monitoring. Congress is also currently considering several pieces of legislation across HHS programs to bolster existing program integrity requirements or require new ones altogether.

Given these developments, the Department seeks to adopt advanced data analytics, artificial intelligence (AI)-enabled monitoring, and forensic review tools to identify anomalies, detect improper payments, and support program integrity efforts across multiple benefit programs. Vendors should anticipate that state needs will include both technology solutions and human expertise to support risk assessments, case prioritization, forensic analysis, and audit readiness.

The Department currently relies heavily on complaints, tips, and staff‑initiated referrals to identify possible FWA. Data mining and proactive analytics are limited and inconsistent across programs.

The Department is interested in exploring a contingency-based program integrity contract. This model would likely leverage both data analytics and contract staff to identify and support FWA case development.

II. Description of Items or Service Required

The Department seeks to understand the marketplace capabilities of vendors who can provide a combination of:

· Advanced analytics, machine learning, and AI solutions

· Data mining

· Case prioritization algorithms

· Human staff or hybrid AI/human review teams

· Support for developing case packages for potential administrative or legal action

· Enterprise‑level detection and response

The Department aims to:

1. Increase identification of potential FWA using data mining and AI, rather than only complaint‑based referrals.

2. Improve prioritization of cases based on risk and likelihood of recovery.

3. Optimize use of state investigators by routing complex, high priority cases to program integrity teams.

4. Understand market pricing, including contingency-based models.

5. Identify vendors’ capabilities to support both detection and case development.

6. Evaluate enterprise-wide applicability rather than one-off solutions for single programs.

Implementation for this program is estimated to be July 1, 2027.

III. Requested information

It is requested that interested vendors provide the following information:

A. Company Overview

· Describe your organization, size, and years of experience providing FWA detection and program integrity services.

· Provide examples of similar work with public benefit programs (Medicaid or non‑Medicaid), including:

· reduction in error rates

· improved recovery or prevention

· Identify any subcontractors or partners you typically work with.

B. Technical Capabilities

· Describe your data mining, AI, machine learning, and analytics capabilities.

· What types of data can your solution ingest (eligibility data, payment data, case notes, third‑party data, etc.)?

· How does your solution navigate non-standardized data?

· Does your solution support:

· anomaly detection

· predictive prioritization

· network analysis

· pattern detection

· cross‑program analytics

· secure data transfer processes

· Describe any hardware/software requirements you currently use or recommend to support this project.

C. Human/Hybrid Support Services

· What quantity and level of staff support do you offer (e.g., analysts, investigators, case developers)?

· Do you assist in preparing case packages for administrative, civil, or criminal action?

· What roles do your staff typically perform?

D. Workflow and Integration

· Describe how your system prioritizes or “stratifies” potential cases.

· Describe reporting capabilities and dashboards.

· How would your solution integrate with existing state systems, complex legacy systems, and external data sources.

· Provide examples of how referrals are fed to DHW investigators.

E. Cost Model & Contingency Contracting

· Describe all available pricing models, including contingency based.

· For contingency-based models:

· What percentage ranges do vendors typically charge?

· What level of service changes based on those ranges?

· How would the vendor define “verified savings” or “recoveries?”

· Would the vendor require any upfront cost, implementation fee, or minimum payment?

· Provide details on how costs are structured across multi-program engagements, if applicable.

· Are there any volume discounts or payment options which may affect pricing?

· What are the estimated cost savings of each?

· Are there any other items or services which will affect pricing?

· What is the estimated cost of each?

F. Legal and Policy Considerations

· Describe any statutory authority typically required to support recoveries.

· Provide examples of any known best practices from other state’s approaches to coordination with prosecutorial partners (county, State Attorney General offices, etc.) to lead to successful prosecution and funds recovery.

· Identify any potential limitations the Department should consider.

· Confirm that you would not use our data to train, develop, or enhance AI models for any customers or products other than the services you provide to us.

G. Enterprise-Wide Options

· Can your solution cover multiple benefit programs under one (1) umbrella contract?

· What are the advantages or disadvantages of multi-program vs. single-program scopes?

· How do you handle enterprise-level analytics and shared risk scoring?

H. Timeline

· Based on the estimated value of programs, $126M, how long do you estimate that it will take to provide each of the items or services described in this RFI?

· What issues may affect the delivery or need to be addressed in the preparation of an RFP?

IV. Terms and Conditions

A.

All material submitted in response to this RFI becomes the property of the Department and will not be returned to the responding vendor.

B.

At the sole discretion of the Department the information provided may be used for the following purposes:

1. Identifying issues and refining the requirements for a solicitation which may be released at a later date.

2. Assisting in projecting a budget for acquiring the services.

3. Identifying potential vendors who may be interested in providing a future competitive proposal.

C.

The Idaho Public Records Act, Idaho Code Title 74, allows the open inspection and copying of public records. Public records include any writing containing information relating to the conduct or administration of the public's business prepared, owned, used, or retained by a state or local agency regardless of the physical form or character. All, or most, of the information contained in your response will be a public record and as such will be subject to disclosure under the public records law. Certain exemptions from disclosure can apply, one of which may be for “trade secrets” as defined in the Idaho Public Records Act, Idaho Code Section 9-340D(1), a copy of which is available for viewing on-line at: https://legislature.idaho.gov/statutesrules/idstat/Title74/T74CH1/SECT74-107/.

1. Trade secrets include a formula, pattern, compilation, program, computer program, device, method, technique or process that derives economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by other persons and is subject to the efforts that are reasonable under the circumstances to maintain its secrecy.

2. If you consider any element of your response to be a trade secret, or otherwise protected from disclosure, you must so indicate by marking each page of the pertinent document. Include the specific basis for your position that it be treated as exempt from disclosure.

3. Marking your response as exempt is not acceptable or in accordance with the Public Records Act and will not be honored. In addition, a legend or statement on one (1) page that all or substantially all of the response is exempt from disclosure is not acceptable or in accordance with the Public Records Act and will not be honored. Prices quoted in your response are not a trade secret.

4. The Department, to the extent allowed by law and in accordance with these terms and conditions will honor a designation of nondisclosure. You will be required to defend any claim of trade secret or other basis for nondisclosure in the event of an administrative or judicial challenge to the Department’s nondisclosure. Any questions regarding the applicability of the Public Records Law should be addressed to the Department or should be presented to your own legal counsel - prior to submission.

D.

THIS IS NOT A BID, NO AWARD WILL BE MADE.

V. Address for Responses

If you are interested in providing any of the information requested in this RFI, please submit your written response by close of business August 31, 2026 to:

*Responses will only be accepted by e-mail.*

**Do Not Submit Your Response Through IPRO/Jaggaer - the eprocurement system.** Idaho Dept of Health & Welfare

Attention: (RFI1406) (Management Services)

Name of CAPS contact: Grace Helie Email: grace.helie@dhw.idaho.gov Telephone: 208-334-5613