Fraud, Waste, and Abuse System

The North Dakota Department of Health and Human Services Medical Services Division is conducting a Request for Information (RFI) to develop a sophisticated fraud, waste, and abuse detection system for its Medicaid program. The state seeks to engage with suppliers experienced in developing advanced analytics platforms capable of identifying potential fraudulent activities across a complex healthcare ecosystem encompassing 23,020 individual providers, 3,391 group providers, and 108,148 total members processing approximately 3.5 million traditional Medicaid claims annually. The primary objective is to enhance the Program Integrity Unit's (PIU) capabilities through an automated system that can detect improper provider activities, prevent inappropriate payments, and facilitate overpayment recovery. Interested suppliers must submit an RSVP by September 10, 2025, with the first five respondents invited to participate in virtual strategy discussions scheduled for mid-September 2025. Each discussion will last approximately one hour, focusing on system capabilities, integration potential, and technological approaches to fraud detection. The ideal solution must seamlessly integrate with the existing Medicaid Management Information System (MMIS) or Data Warehouse, support various healthcare interoperability standards, and demonstrate robust data analysis capabilities.

While no specific set-aside designations were explicitly noted in the RFI, the procurement appears open to qualified technology vendors with demonstrated expertise in healthcare fraud detection systems. The state anticipates issuing a formal Request for Proposal (RFP) contingent upon funding review, RFI results, and CCS approval, with the intent to award the contract to a single vendor. The current infrastructure includes an existing MMIS and Data Warehouse, which means any proposed solution must demonstrate comprehensive integration capabilities. No specific budget range or award value was disclosed in the documentation, suggesting that the state is primarily focused on gathering market intelligence and understanding potential technological solutions before defining precise financial parameters. The procurement represents a strategic initiative to modernize fraud detection mechanisms within North Dakota's Medicaid program, leveraging advanced data analytics and complex computational techniques to improve overall program integrity and financial oversight.