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OptumInsight provides comprehensive retrospective case development and recovery services that cover the entire process, from initial identification to final recovery.
Our services can help your organization save significant expense by: Identifying overpayments that result from error, waste, fraud, and abuse Developing cases with high recovery potential Successfully negotiating and recovering payments
A retrospective approach digs into historical claims to spot patterns and trends that suggest fraudulent activity. OptumInsight investigates those cases—using expert evidence analysis, interviews, medical records reviews, and case documentation—and sends those with recovery potential to an experienced team of professionals who then coordinate recovery on a contingency basis.
The recovery team determines and develops strategies for negotiating recovery, arranging settlement agreements, and recovering overpayments. Several factors inform those strategies, including the degree of opportunity for financial recovery, ongoing law enforcement actions, and factors specific to each case. OptumInsight Retrospective Fraud, Waste and Abuse Investigation components are structured in a way that allows you to select the features that most effectively serve your needs, whether that is an augmentation of your internal efforts or a full outsourcing solution.
Fraud Detection and Recovery Services Download PDF.
Fraud and Abuse Detection System Download PDF.
The Key to Detecting Fraud and Abuse in Medical Billing Download PDF.
Using technology to enhance pre-payment fraud detection: a multidimensional strategy Read more.
