Systems Analysis and Vulnerability Assessments

Improve the operation and efficiency of Medicaid programs

Optum™ provides deep public sector expertise and a full range of program integrity solutions to support government efforts in identifying appropriate payment upfront, as well as retrospectively recovering inaccurate, inappropriate, or fraudulent Medicaid payments.

Identifying areas of vulnerability and opportunity for savings and improvement is an essential part of any effective payment accuracy or program integrity effort. The Systems Analysis and Vulnerability Assessments team at Optum™ brings deep expertise. Former Medicaid and Medicare program leaders, policy experts, fraud investigators, public finance analysts, and others help you identify areas of vulnerability and suggest cost saving opportunities.

Optum Systems Analysis and Vulnerability can help you:

  • Identify areas of potential risk
  • Pinpoint corrective actions to mitigate the risk
  • Develop a prioritized plan for system improvements

Optum Systems Analysis and Vulnerability assessments often begin with a focus on program integrity/payment accuracy efforts. However, it is not uncommon for the discussions to also identify areas where state policy and procedures can be tightened, revised, or rewritten entirely.

Through this type of collaborative effort, state Medicaid staff (and staff from related program areas) can take full advantage of having “another set of eyes and ears” involved in their discussion — with the goal of achieving significant cost savings and improving the operation and efficiency of their Medicaid program.