AR HCR1010

Authorizes Representative Bruce Westerman to introduce legislation creating a new subchapter under Arkansas Code Title 20, Chapter 77 to implement waste, fraud, and abuse prevention and detection programs for Medicaid and ARKids First.

Requires the Department of Human Services to establish a centralized database of all claims-based data for both programs and implement automated reviews of provider payments to prevent inappropriate payments to deceased, barred, retired, or unlicensed providers.

Mandates acquisition of state-of-the-art clinical code editing technology and predictive modeling analytics to identify billing errors, overbilling, and fraudulent patterns before claims are paid.

Establishes fraud investigative programs combining retrospective claims analysis and prospective detection techniques, including review of historical claims data, medical records, and suspect provider databases.

Requires the Department to contract with entities meeting specified technical and clinical qualifications and submit reports to legislative committees within three months of completing each implementation year, including actual and projected savings, return on investment, and impact on recipients and providers.