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2019 SESSION
19105101DBe it enacted by the General Assembly of Virginia:
1. That § 32.1-319.1 of the Code of Virginia is amended and reenacted as follows:
§ 32.1-319.1. Department to establish pilot program to use data analytics to mitigate risk of improper payments.
A. The Department shall establish conduct a pilot
program using prepayment analytics to develop means to mitigate
the risk of improper payments to providers of services that are paid through
the Department's fee-for-service delivery system who commit fraud, abuse, or
errors. Such program 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
prepayment analytics to identify providers and claims 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 that are paid through the
Department's fee-for-service delivery system furnished under the state
plan for medical assistance and all applicable waivers required by this
section.