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About Fraud, Waste and Abuse

Definitions of Fraud, Waste and Abuse as Related to Health Care

  • Fraud is the intentional misrepresentation of information to gain undeserved payment for a claim.
  • Waste involves spending federal health care dollars on services that are unnecessary.
  • Abuse involves a questionable practice, which is inconsistent with accepted medical or business policies.

Impact of Fraud, Waste and Abuse

The National Health Care Anti-Fraud Association estimates conservatively that health care fraud costs the nation about $68 billion annually - about 3 percent of the nation's $2.26 trillion in heath care spending. The FBI estimates losses could be as high as 10% per year or $300 billion.

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