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For more than 20 years, Optum Serve® has partnered with federal health customers to mitigate fraud, waste and abuse (FWA) and improper payments. We combine IT capabilities with commercial, private and state FWA experience.

We partner to establish a modernized, flexible framework for risk management. This includes advanced tools like artificial intelligence and machine learning, based on best practices we’ve established in our commercial health care division.

We also establish customer-specific frameworks for tailored program integrity (PI) use cases, including predictive analytics and integrating diverse data sets.

Our capabilities:

  • Policy analytics
  • Prepay claims editing
  • Data analytics and visualization
  • Payment integrity and recovery
  • Artificial intelligence and machine learning for FWA
  • Benefit eligibility and provider screening automation

FWA expertise and technology

  

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$30B

Optum Serve has saved or recovered $30B for 133 clients and 62 health plans.1

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25,000+

We have over 25K+ technologists, data scientists, actuaries and clinicians to help curb fraud, waste and abuse.2

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250M+

Optum maintains a database covering over 250 million deidentified lives of data used to foster innovation and research across health care.1

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With our combined capabilities we can manage any PI platform

We bring advanced IT services in cloud modernization, GitOps/DevSecOps, data management and robotic process automation.

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Fresh insights

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Resource

Visualizing fraud, waste and abuse

Graph analytics and machine learning drive the future of program integrity.

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Infographic

Deliver program integrity efficiencies

Curb fraud, waste and abuse for federal agencies.

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White paper

Leveraging commercial health care technologies

Apply AI and program integrity practices in government.

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Case study

Optum Serve: Protecting taxpayer dollars

Eliminate fraud, waste and abuse in health care spending.

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Sources

  1. Optum book of business as of Q1 2022.
  2. Optum. Machine Learning and Advanced Technology. August 2019. Accessed October 26, 2021.