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Program Integrity Services

Our solution enhances and modernizes program integrity to combat fraud, waste and abuse by working to support the federal government.

Partnering to mitigate fraud, waste and abuse

For more than 20 years, Optum Serve has partnered with federal health customers to mitigate fraud, waste and abuse (FWA) and improper payments. We combine IT capabilities with commercial, private and state FWA experience.

We partner to establish a modernized, flexible framework for risk management. This includes advanced tools like artificial intelligence and machine learning, based on best practices we’ve established in our commercial healthcare division.

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Customer-specific frameworks

We also establish customer-specific frameworks for tailored program integrity (PI) use cases, including predictive analytics and integrating diverse data sets.

Our capabilities 

  • Policy analytics 
  • Prepay claims editing 
  • Data analytics and visualization 
  • Payment integrity and recovery  
  • Artificial intelligence and machine learning for FWA  
  • Benefit eligibility and provider screening automation

Key benefits

$30B saved or recovered

Optum Serve has saved or recovered $30B for 133 clients and 62 health plans.1

Over 25,000 experts

We have over 25,000 technologists, data scientists, actuaries and clinicians to help curb fraud, waste and abuse.2

More than 250M points of data

Optum maintains a database covering over 250 million deidentified lives of data used to foster innovation and research across healthcare.1

Working with our federal health customers

Optum Serve helps federal agencies reduce fraud, waste and abuse through partnerships, technologies solutions and best practices. Download the e-book to see how we address challenges and support federal agencies unique needs.

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Related healthcare insights

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Article

Visualizing fraud, waste and abuse

Graph analytics and machine learning drive the future of program integrity.

Infographic

Deliver program integrity efficiencies

We help federal agencies with an effective data strategy and analytic roadmap to predict and prevent fraud, waste and abuse.

Case study

Optum Serve: Protecting taxpayer dollars

Eliminate fraud, waste and abuse in healthcare spending.

With our combined capabilities we can manage any PI platform

Get in touch with our sales team today

Fill out this form and we’ll get back to you shortly.

Already a customer? Find your support portal.

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  1. Optum book of business as of Q1 2022.
  2. Optum. Machine Learning and Advanced Technology. August 2019. Accessed October 26, 2021.