Don’t settle for “good enough” when a better solution exists. Fraud, waste and abuse (FWA) is a serious problem, one that can also be seriously misleading for healthcare payers looking to transform their revenue streams. That’s because many health plans mistake strong FWA savings as a holistic program when, in actuality, it’s only a part of the bigger picture. That’s right: only investing in FWA solutions means your plan is leaving money on the table and missing out on total payment integrity. What is Fraud, Waste and Abuse? To start, let’s define what FWA is:
- Fraud is an intentional attempt to defraud a health care benefit program.
- Waste is a misuse of resources that leads to unnecessary costs to a health care benefit program.
- Abuse is a mistaken payment for services or items when no legal entitlement to such a payment exists.