Reporting Fraud, Waste or Abuse

Healthcare Fraud, Waste, and Abuse (FWA) are serious issues that can undermine the integrity of the healthcare system, leading to unnecessary costs, poor care quality, and potential harm to patients. These unethical practices take many forms, from billing for services not rendered to overutilization of medical services, and they can affect patients, providers, payers and the entire healthcare system.

It is crucial for everyone-patients, healthcare providers, and employees within healthcare organizations- to play an active role in identifying and reporting these fraudulent, wasteful, and abusive practices. By reporting FWA, you help ensure that healthcare resources are used efficiently and that all individuals involved in healthcare receive fair treatment and quality care.  

This page provides information on how you can identify FWA and the proper channels for reporting suspected cases. Your contribution is vital in safeguarding the integrity of our healthcare system and protecting public trust.

Keep a look out for a few simple things, such as:

Be cautions of free offers, “too good to be true”
If you are offered free products, services, or money, be careful.

Avoid identity theft
Protect your personal information, do not share your ID card information with anyone other than a healthcare professional.

Review your medical statements
Regularly check your explanation of benefits (EOB) statements and medical bills for any services that you didn’t receive.

Know your rights
Understand your health plan’s benefits coverage, and limitations.  This knowledge can help you spot inconsistencies and avoid being taken advantage of.

Billing for services not provided 
This involves submitting claims for services that were never provided to the patients, often by falsifying records

Upcoding
This is the practice of billing for a more expensive service or procedure than what was actually provided, in order to increase reimbursement.

Unnecessary services
This occurs when health providers perform and bill for services, test, or procedures that are not medically necessary, purely to increase their income.

Pharmaceutical fraud
This involves issues live over-prescribing medications or billing for drugs that were never dispenses. It can also include the distribution of counterfeit medications.