This Day On The Street
Continue to site right-arrow
ADVERTISEMENT
This account is pending registration confirmation. Please click on the link within the confirmation email previously sent you to complete registration.
Need a new registration confirmation email? Click here
Stocks Under $10 with 50-100% upside potential - 14 days FREE!

Optum And SAS Align To Help Prevent Health Care Fraud, Waste And Abuse

Stocks in this article: UNH

Optum, an industry leader in health care payment integrity services, is working with SAS to further enhance its comprehensive health care anti-fraud, waste and abuse services. This enhanced solution combines detection, investigation, prevention, case development and recovery services to provide commercial health plans with a flexible approach to ensuring proper payments to care providers.

While the vast majority of health care spending reflects the actual costs of patient care and medical services, the National Health Care Anti-Fraud Association (NHCAA) estimates that $60 billion is lost annually to health care fraud, waste and abuse. This figure includes such activities as billing for unperformed medical services; performing a medically unnecessary test or procedure; billing for more expensive medical services or procedures than the one conducted; or billing each stage of a procedure in place of a bundled rate.

“Health plans find it challenging to assemble the complex combination of technology and talent required to mount sophisticated anti-fraud defenses,” said Nick Howell, Optum’s senior vice president of operational and administrative efficiency. “By working with SAS, we can further enhance our support of payers seeking to access most sophisticated analytics, the largest datasets, and the largest investigative operations in the industry.”

The Optum solution uses SAS’s Fraud Framework and Optum’s deep health care expertise and extensive health care claims and fraud case datasets to identify and prevent instances of fraud, waste and abuse for payers. The solution delivers broad detection capabilities including rules, flags, predictive modeling, text mining and social network analysis to identify possible instances of provider and consumer fraud, including multi-party fraud schemes and organized crime.

“This solution has a proven track record of detecting improper payments early and stopping them before they negatively impact the health care system,” said Julie Malida, principal for Health Care Fraud Solutions, SAS. “Together, SAS and Optum are uniquely positioned to help the industry address the growing issue of health care fraud, waste and abuse, which shows no signs of abating without intervention.”

1 of 2

Select the service that is right for you!

COMPARE ALL SERVICES
Action Alerts PLUS
Try it NOW

Jim Cramer and Stephanie Link actively manage a real portfolio and reveal their money management tactics while giving advanced notice before every trade.

Product Features:
  • $2.5+ million portfolio
  • Large-cap and dividend focus
  • Intraday trade alerts from Cramer
  • Weekly roundups
TheStreet Quant Ratings
Try it NOW
Only $49.95/yr

Access the tool that DOMINATES the Russell 2000 and the S&P 500.

Product Features:
  • Buy, hold, or sell recommendations for over 4,300 stocks
  • Unlimited research reports on your favorite stocks
  • A custom stock screener
  • Upgrade/downgrade alerts
Stocks Under $10
Try it NOW

David Peltier, uncovers low dollar stocks with extraordinary upside potential that are flying under Wall Street's radar.

Product Features:
  • Model portfolio
  • Stocks trading below $10
  • Intraday trade alerts
  • Weekly roundups
Dividend Stock Advisor
Try it NOW

Jim Cramer's protege, David Peltier, identifies the best of breed dividend stocks that will pay a reliable AND significant income stream.

Product Features:
  • Diversified model portfolio of dividend stocks
  • Alerts when market news affect the portfolio
  • Bi-weekly updates with exact steps to take - BUY, HOLD, SELL
Real Money Pro
Try it NOW

All of Real Money, plus 15 more of Wall Street's sharpest minds delivering actionable trading ideas, a comprehensive look at the market, and fundamental and technical analysis.

Product Features:
  • Real Money + Doug Kass Plus 15 more Wall Street Pros
  • Intraday commentary & news
  • Ultra-actionable trading ideas
Options Profits
Try it NOW

Our options trading pros provide daily market commentary and over 100 monthly option trading ideas and strategies to help you become a well-seasoned trader.

Product Features:
  • 100+ monthly options trading ideas
  • Actionable options commentary & news
  • Real-time trading community
  • Options TV
To begin commenting right away, you can log in below using your Disqus, Facebook, Twitter, OpenID or Yahoo login credentials. Alternatively, you can post a comment as a "guest" just by entering an email address. Your use of the commenting tool is subject to multiple terms of service/use and privacy policies - see here for more details.
Submit an article to us!

Markets

DOW 17,804.80 +26.65 0.15%
S&P 500 2,070.65 +9.42 0.46%
NASDAQ 4,765.38 +16.9840 0.36%

Brokerage Partners

Rates from Bankrate.com

  • Mortgage
  • Credit Cards
  • Auto

Free Newsletters from TheStreet

My Subscriptions:

After the Bell

Before the Bell

Booyah! Newsletter

Midday Bell

TheStreet Top 10 Stories

Winners & Losers

Register for Newsletters
Top Rated Stocks Top Rated Funds Top Rated ETFs