Over the last ten years, Optum Workers’ Comp and Auto No-Fault has elevated fraud, waste, and abuse mitigation to a core strategic focus. By creating sophisticated programs, unique system capabilities and comprehensive analytics, Optum has established a multi-layered framework centered on prevention.
Through the use of real-time claims activity tracking alongside broad and individual-level reviews of providers, pharmacies, and injured persons, Optum detects concerning patterns early. This integrated approach helps pinpoint elevated risk and supports faster, more informed responses.
Emphasizing early action is vital in a complex care environment, where minor process breakdowns can quickly translate into substantial expense and suboptimal treatment. Timely, preventive oversight helps reduce downstream impact while safeguarding injured individuals and program integrity.