OptumInsight Fraud and Abuse Detection System

OptumInsight Fraud and Abuse Detection System (IFADS), is solution suite comprised of complementary tools designed to help manage fraud and abuse investigations from detection through collection. When all components are installed, IFADS allows jurisdictions to meet 100 percent of the CMS Program Integrity Business Area Checklist requirements.

IFADS provides advanced analytical models that identify patterns in claims data which are often indicative of fraud, abuse, error, and waste. IFADS includes a powerful OptumInsight Surveillance and Utilization Review System (ISURS) which provides on-demand, real-time, peer-to-peer comparisons of provider billings and recipient utilization of services.

IFADS can help you:

• Identify potential fraud and abuse, track investigations and recoupments
• Research unusual behaviors, with a minimum of false positives
• Confidently pursue irregular activity on the part of both providers and recipients