Retrospective fraud analysis

We help you identify suspicious claims patterns and recover improper payments.

Our retrospective fraud detection services analyse large volumes of historic claims data to identify irregular billing patterns and suspicious providers.

Fraud prevention begins with the identification of irregular billing practices and suspicious claims patterns. Unfortunately, an overwhelming number of patients and a lack of resources prevent many health care organisations from detecting fraud patterns before claims are paid.   

OptumTM uses predictive analytics to uncover fraudulent claims post-payment. Our retrospective fraud detection solution leverages trends analyses and extensive datasets to identify suspect providers and flag them for investigation. This information can then be used to recommend or deny payment and begin recovery efforts.

Our flexible, scalable approach helps contain costs by:

  • Identifying overpayments and wasteful, abusive practices
  • Identifying suspect providers by leveraging trend analyses
  • Developing cases with high recovery potential
  • Eliminating the need for software installation and maintenance

Contact us today to learn how Optum retrospective fraud detection services can help you detect fraud, waste and abuse through post-payment claims analysis.