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