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Optum Fraud and Abuse Detection System

Manage fraud and abuse investigations from detection through collection.

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Features and benefits


End-to-end tracking for FFS and managed care

The Optum® Fraud and Abuse Detection System (FADS) supports both fee-for-service (FFS) and encounter data provided through managed care plans. 

All FADS components support encounter data analysis, including: 

  • Peer group profiling
  • Focused analytics
  • Provider activity spike detection
  • Long-term care review
  • High-cost members
  • Browse and search of claims
  • Case tracking

Detect overpayments

FADS provides a suite of discovery components to help Medicaid agencies detect overpayments accruing from fraud, waste and abuse (FWA).

  • Peer group profiling. Our Surveillance and Utilization Review Subsystem (SURS) provides a user-friendly interface that lets you create meaningful and customized statistical analysis. That helps you discover abnormal behaviors within defined peer groups. 
  • Focused analytics. These powerful data mining solutions use advanced logical algorithms that perform intraclaim and cross-claim comparisons. This helps identify potentially fraudulent or abusive behaviors.
  • Provider activity. Proactively evaluate your entire provider population to identify any significant increases or decreases in billing activity. Quickly detect providers with high growth rates.
  • High-cost member analysis. Detect and analyze member IDs that incur excessive health care costs.
  • Long-term care review. Examine the services used by residents of long-term care facilities to quickly and easily identify and review suspicious behaviors. 

Pursue suspicious activity 

Pursue suspicious activity on the part of both providers and members with our suite of FADS research components.

  • Browse and search. Review providers, members and all FFS and MCO claims without leaving the FADS software.
  • Random sampling: Quickly and easily create a random sample of claims from within FADS itself. This eliminates the need for a third-party statistical application. 
  • Report library. Increase efficiency with predefined reports that are updated weekly including encounter claims for individual MCO comparison. 
  • Reference codes. Translate code into text.

Track progress

FADS includes an easy-to-use integrated case management tool. It was built with feedback from multiple program integrity groups and so it's specifically designed for the needs of program integrity. 

Case tracking contains pages that allow investigators to track cases through the investigative process until the case is resolved.

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MECT certified

FADS has been certified under the MECT 2.3 MMIS Module for Program Integrity and can also interface with treatment grouping capabilities. This is important for states seeking enhanced federal matching funds for their FWA operations.


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Cost avoidance savings

Results from FADS can support provider education, prevent improper payments related to FWA, and identify policy gaps and emerging trends. All of this can help avoid unnecessary costs. 

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