Introduction in Fraud, Waste & Abuse (FWA) in Healthcare:

Healthcare fraud, waste, and abuse are significant problems that cost the U.S. healthcare system billions of dollars each year.

These unethical practices undermine the integrity of the system and divert resources away from essential patient care. 

Understanding the scope and impact of this issue is the first step towards developing effective solutions.

Types of Fraud, Waste & Abuse:

Billing Fraud - Submitting claims for services not rendered, using incorrect billing codes, or billing for more expensive procedures

Overutilization - Ordering medically unnecessary tests, procedures, or treatments to increase reimbursements

Phantom Billing - Billing for services or supplies that were never provided to patients

Kick-backs & Referral systems - Providers receiving payment for referring patients to certain labs, pharmacies, or other providers.

Financial Impact on the Healthcare System:

Staggering Costs - Fraud, waste, and abuse in healthcare cost the system hundreds of billions of dollars annually, significantly impacting budgets and limiting resources for patient care.

Bloated Expenses - Inflated billing, unnecessary procedures, and other fraudulent practices drive up healthcare costs, leading to higher insurance premiums and out-of-pocket expenses for patients.

Diminished Access - The financial burden of fraud and waste can restrict access to quality healthcare, particularly for underserved and marginalized communities that rely on public programs.

Eroded Trust - Widespread fraud and abuse erodes public trust in the healthcare system, making patients less likely to seek care and undermining the provider-patient relationship.

Healthcare Research, Research on Fraud Patterns