Prevention and Detection
We help prevent and detect potential FWA through many sources. These include:
- UnitedHealthcare Payment Integrity functions
- Optum Companies within UnitedHealth Group
- Health care providers
- Health plan members
- Federal and state regulators and task forces
- News media
- Professional anti-fraud and compliance associations
- CMS websites: sam.gov/SAM
We also monitor and audit prevention and detection by:
Prospective Detection:
- Pre-Payment Data Analytics
- Data Mining Queries
- Abnormal Billing Patterns
- Other activities to determine if we need additional prospective activities.
Retrospective Detection:
- Post-Payment Data Analytics
- Payment Error Analytics
- Industry Trend Analysis
- Care Provider Audits