Fraud, Waste and Abuse Awareness

Healthcare insurance fraud, waste and abuse (FWA) costs the US approximately $130B each year, resulting in reduced benefits, higher taxes, increased premiums and increased costs for all Americans. To uncover fraudulent and abusive behavior, investigators and auditors sort through huge amounts of claims data and rely upon tips from fraud hotlines.

FWA Definitions:

• Fraud: is an intentional representation that an individual knows to be false or does not believe to be true and makes anyway, knowing that the representation could result in some unauthorized benefit to him/herself or some other person.

• Waste: is generally defined as activities involving payment or the attempt to obtain reimbursement for items or services where there was no intent to deceive or misrepresent but the outcome of poor or inefficient billing or treatment methods causes unnecessary costs.

• Abuse: is generally defined as activities that unjustly enrich a person through the receipt of benefit payments but where the intent to deceive is not present; or is an attempt by an individual to obtain a benefit payment he or she does not deserve.

Suspect Fraud, Waste or Abuse?

Call Our Toll-Free Hotline:

888-205-2211