Every year, plan sponsors lose as much as $300 billion to healthcare fraud, waste, and abuse. Optum Rx Fraud, Waste, and Abuse Audit Services run 24/7 behind the scenes at no cost to our clients and save significant dollars. See how Optum Rx can help you prevent, detect, and correct these errors.
This latest case study showcases how we were able to recover $315,000 within six months for a nursing union representing 1.2 million lives. The audit identified 147 suspected fraud violations from five independent pharmacies, a more than 300% increase in total recoveries from suspected fraud claims, and a 135% increase in total recoveries from investigative audits. In addition to helping this client, the fraud uncovered by this audit also led to the termination of 45 pharmacies within our network and, in doing so, generated $80.5 million in cost avoidance for other clients.
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