Fraud Waste and Abuse

Fraud Waste and Abuse is typically a term most commonly used in government and healthcare and refers to several types of negligent and possibly criminal behavior.

As defined by United States Code 1347, Fraud is “knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program; or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program.” It is illegal to knowingly submit false information in order to receive a monetary or other benefit, the definition of fraud.

Waste and abuse, on the other hand, do not require intent and knowledge of wrongdoing. Abuse might take the form of a payment for items or services that have no substantiated basis for payment and/or for which the provider has not knowingly or intentionally tried to get paid. Waste usually refers to the inefficient use of services and is generally not the result of criminal negligence.