Retrospective Fraud, Waste and Abuse Investigation Features

OptumInsight Retrospective Fraud, Waste and Abuse Investigation services help you identify the cases with the greatest potential for recovery so you can focus your resources appropriately and secure an economically attractive resolution.

Our experts help you:

• Evaluate allegations and determine whether a case should be opened
• Analyze providers’ claim billing patterns to identify aberrations
• Develop audit samples via the use of statistical sampling methodologies
• Use clinical investigators to review medical records
• Determine appropriate resolution strategy
• Package case for Department of Insurance and/or other law enforcement handling the case
• Present case to license and/or medical board
• Initiate recovery efforts
• Disburse funds to appropriate entities