Colorado Department of Health Care Policy & Financing Deploys New AI-Enabled Technology to Strengthen Program Integrity

New tool strengthens Colorado Medicaid's ability to safeguard taxpayer dollars against fraud, waste and abuse

FOR IMMEDIATE RELEASE

August 17, 2026

Media Contact
Marc Williams
Department of Health Care Policy & Financing
720-626-0801 (Cell)

Denver, CO - The Colorado Department of Health Care Policy and Financing (HCPF) has received certification from the Centers for Medicare and Medicaid Service (CMS) on a new AI-enabled technology to enhance HCPF's Program Integrity efforts to detect and combat fraud, waste and abuse (FWA) in Health First Colorado (Colorado's Medicaid program).

HCPF's tool, the FWA Finder™ by Alivia, analyzes provider, member, claims, and financial data to identify outliers and anomalies across large data sets for potential fraud, waste or abuse. The tool allows FWA staff to quickly triage and investigate referrals and track overpayments and recoveries.

Since the Department received CMS certification of the system implementation in May, the FWA Finder has already provided enhanced FWA detection capabilities through robust data modeling and customizable analytic capabilities. The tool has produced 82 new FWA leads to pursue that otherwise would have been difficult and time consuming for HCPF staff to detect with old methods.

FWA Finder is accompanied by a case management solution, also from Alivia, called the Recoveries Electronic Database (RED). The case management solution does not pertain to member case management but rather allows HCPF to maintain program integrity documentation for audits and reviews, tracking and reporting more effectively on FWA activities such as provider suspensions and terminations, capturing information and evidence in provider investigations, referring cases to law enforcement, monitoring current and former audits, and logging referrals of member and provider fraud.

"HCPF has implemented this new advanced analytics tool to improve recoveries, strengthen program integrity, and more quickly identify areas of high-risk," said Medicaid Operations Division Director Ralph Choate. "This initiative is one part of HCPF's ongoing commitment to improving the Medicaid program by enhancing our ability to identify and prevent fraud, waste, and abuse in conjunction with our state and federal partners."

The FWA Finder helps HCPF comply with federal and state program integrity requirements while improving coordination, reporting, and data-driven decision-making.

"This is just one of the new tools that HCPF is implementing to allow us to focus resources where we can achieve the most impact, save the state the most money, and ensure proper billing through targeted provider auditing and education," added FWA Division Director, Ashley Dirienzo. "The FWA Finder tool gives the Department insight into provider comparisons to help us target individuals or groups that may be high-risk compared to their peers."

The new FWA Finder technology is one of several Program Integrity enhancements that HCPF has made in recent years and establishes a new pathway to continuing to enhance efforts in the future, particularly around preventing improper payments. HCPF also uses a prepayment claim editing software, ClaimsXten, to identify claims that have inappropriate coding elements that should not be paid. ClaimsXten comes with hundreds of pre-developed edits based on nationally recognized Medicaid coding and claims payment rules and requirements, meaning HCPF does not have to spend a lot of time developing them.

HCPF will continue to source additional technology and analytical enhancements to streamline operations and develop new ways to identify and combat fraud, waste & abuse that is constantly evolving.

About the Colorado Department of Health Care Policy & Financing

The Department administers Health First Colorado (Colorado's Medicaid program), Child Health Plan Plus, and other programs for Coloradans who qualify. These health care programs now cover about one in four Coloradans. For more information about the Department, please visit hcpf.colorado.gov.