Arizona's Medicaid program will launch AI tool to detect fraud

Starting in July, Arizona will launch an artificial intelligence system that will review medical records before paying for Medicaid claims.

Gov. Katie Hobbs says it will be used to detect fraud in the AHCCCS program. The governor’s office says the AI tool will rank submitted claims based on waste and fraud risk.

AHCCCS Inspector General Venessa Templeman says there will also be human oversight.

“There is continuous human interaction that is taking a look at these different items that are coming out and are being flagged," Templeman said.

The announcement comes a day after Vice President JD Vance announced the federal government is withholding $1.3 billion in Medicaid funds from California over fraud allegations.

The federal government also sent states letters warnings to investigate Medicaid fraud or risk losing funding. But Templeman says talks to bring on the tool started long before those letters.

“To take a look at stopping fraud before it happens versus waiting for the output from that prepaid traditional aspect to discover fraud and then to react later," Templeman said.

Templeman says that if anyone has concerns about health care fraud, waste or abuse, she encourages submissions via:

• Calling the AHCCCS fraud hotlines: 602-417-4045 or toll-free at 888-487-6686
• Submitting an email to [email protected]
• Filling out an online form that provides an opportunity to remain anonymous
• Mailing a complaint in to: AHCCCS OIG, 150 N. 18th Ave., Phoenix, AZ 85007