26AITOSSMHPIKW: Request for Information (RFI) Innovative AI Tools to Support & Strengthen MH Program

Background
The Executive Office of Health and Human Services (EOHHS) of Massachusetts is responsible for administering the state's Medicaid program, known as MassHealth, which includes the Children's Health Insurance Program. The MassHealth Program Integrity Unit (PIU) aims to prevent, identify, and mitigate fraud, waste, and abuse (FWA) within the program. This Request for Information (RFI) seeks input from qualified organizations on innovative applications of AI tools and technologies that can enhance the integrity of post-payment processes and improve overall program functions.

Work Details
EOHHS is soliciting information regarding innovative post-payment applications of AI tools and machine learning technologies that can support MassHealth's efforts in detecting FWA. Key areas of interest include:

1) Analyzing claims and payment information;
2) Interpreting rules, policies, and contractual requirements;
3) Applying solutions across multiple delivery systems such as fee-for-service and managed care;
4) Reviewing medical records for compliance;
5) Ensuring data privacy and security in accordance with HIPAA;
6) Assessing the accuracy of AI tools;
7) Supporting overpayment recovery processes;
8) Measuring success metrics related to FWA detection.

Period of Performance
This RFI was issued on March 16, 2026. It does not specify a defined period for performance as it is solely for information gathering purposes.

Place of Performance
The geographic location for performance is not explicitly stated but is implied to be within Massachusetts as it pertains to the MassHealth program.

Bidder Requirements
Respondents should have experience with AI tools applicable to Medicaid or public-sector programs. There are no specific set-aside certifications or registration requirements mentioned in this RFI.