A New Approach to an Old Problem

Federal health programs face a persistent and growing challenge: how to safeguard critical healthcare dollars while continuing to deliver timely, high-quality care to millions of Americans.

Improper payments, fraud schemes, and inefficient recovery processes continue to strain agency resources—diverting time, funding, and attention away from the populations that need care the most.

Today, that model is evolving.

Codoxo is proud to announce a strategic partnership with Optum Serve to bring a prevention-first approach to payment integrity across federal health programs—helping agencies identify and stop issues earlier in the claims lifecycle, before they become costly problems.

Moving Beyond “Pay and Chase”

For decades, payment integrity has relied heavily on retrospective recovery—identifying improper payments only after they’ve already been made.

While necessary, this approach creates significant downstream challenges:

• Lengthy recovery cycles
• Administrative burden across agencies
• Provider abrasion from audits and appeals
• Delayed resolution of fraudulent activity

This partnership is built on a fundamentally different model.

By combining Optum Serve’s expertise in supporting federal agencies with Codoxo’s cutting-edge technology, this tailored platform will empower agencies to act sooner and more accurately to prevent improper payments. This proactive approach reduces costly rework and appeals, while also accelerating investigations when potential issues arise, ensuring funds remain secure within federal accounts.

Bringing Generative AI to the Earliest Point of Intervention

Codoxo’s platform is designed to identify risk signals across the entire claims lifecycle—with the greatest impact coming from acting early.

Through this collaboration, federal health programs gain access to advanced AI capabilities that enable:

• Early detection of anomalous billing patterns and emerging fraud schemes
• Identification of high-risk claims prior to claim creation
• Faster, more targeted, and efficient investigations
• Improved accuracy and consistency in payment decisions

This earlier intervention reduces costly rework, shortens investigation timelines, and enables agencies to operate more efficiently at scale.

Strengthening Accountability While Expanding Access to Care

At its core, payment integrity is not just about cost containment—it’s about ensuring that healthcare resources are used effectively and equitably.

By preventing improper payments earlier, agencies can:

• Preserve funding for essential healthcare services
• Improve operational efficiency across program integrity teams
• Reduce delays caused by reprocessing and appeals
• Focus resources on delivering care to Veterans, active-duty Service Members, and other vulnerable populations

A Smarter, More Efficient Path Forward

The collaboration between Codoxo and Optum Serve reflects a broader shift happening across healthcare:

From fragmented, reactive models to unified, intelligence-driven platforms that enable prevention at the earliest possible moment.

As Musheer Ahmed notes, this partnership represents an important step forward in expanding the impact of AI-driven payment integrity:

“This partnership allows us to apply our capabilities to federal health programs—helping prevent improper payments before they occur and improving healthcare affordability at scale.”

Looking Ahead

As fraud schemes grow more sophisticated and financial pressures increase, federal health programs need solutions that go beyond traditional approaches.

This partnership marks a meaningful step toward a future where:

• Payment integrity is proactive, not reactive
• Investigations are faster and more precise
• Resources are protected before they are lost

Codoxo and Optum Serve are committed to helping federal agencies lead that transformation.

Read the full press release: https://business.optum.com/content/dam/noindex-resources/business/pdfs/legal-notices/codoxo-partnership-announcement.pdf.

Learn more about Codoxo’s fraud waste and abuse platform.