Health care fraud is the intentional deception or misrepresentation of fact that can result in unauthorized benefit or payment. Abuse means actions that are medically unnecessary or improper, inappropriate, and outside of acceptable standards of professional conduct.
Waste comes from errors, such as incorrect keying of billing codes, misuse of modifiers, and more deliberately through excessive treatments, overuse of medical services, medication and prescription refills, billing for unnecessary medical equipment, and unnecessary medical appointments.
Implementing best practices along with fraud, waste, and abuse (FWA) counter measures payers can continue to mitigate rising health care costs and claims processing waste.