Revolutionizing Medicaid Payment Integrity: AI-Driven Insights for FWA Prevention

In today’s dynamic healthcare landscape, ensuring payment integrity is critical for safeguarding Medicaid funds and delivering quality care. This panel will explore how advanced AI techniques are transforming fraud, waste, and abuse (FWA) prevention through three key innovations: seamless data integration, AI-powered detection, and LLM-enabled user experiences. Drawing on our extensive experience and client work, panelists will discuss how unifying claims, provider, and member data from multiple sources creates a comprehensive analytics foundation—enabling machine learning models to identify hidden fraud patterns and adapt to emerging schemes in real time. In addition, the session will highlight how large language models (LLMs) empower investigators and policy teams with natural language rule creation, interactive analytics, and automated insights to streamline fraud detection processes.

This session will also spotlight AWS’s critical role in enabling robust data integration and scalable AI-driven analytics, demonstrating how cloud-based technologies are revolutionizing Medicaid payment integrity.

Key Takeaways:

• The importance of seamless data integration in building robust analytics for FWA prevention.
• Leveraging AI-powered models to detect hidden fraud patterns in real time.
• Enhancing user experience through LLM-enabled natural language interfaces.
• How AWS cloud solutions underpin scalable, secure, and effective Medicaid payment integrity initiatives.