Fraud, Waste and Abuse

What are fraud, waste and abuse and why do they matter?

We take the detection, investigation and prosecution of fraud, waste and abuse very seriously.

• Fraud occurs when someone knowingly and intentionally executes, or attempts to execute, a scheme to obtain money or property from a healthcare benefit program.
• Waste occurs when services are provided that are not medically necessary.
• Abuse occurs when healthcare providers or suppliers take actions that directly or indirectly result in unnecessary costs to a healthcare benefit program.

Examples of fraud, waste or abuse

Examples of fraud, waste or abuse include:

• Inappropriate billing by a provider, such as billing for a more expensive service than the patient received or submitting multiple claims for the same service.
• Providing or billing for services without a license.
• A provider billing for services you did not receive.
• Conducting more visits that medically necessary.
• Using someone else’s ID card to receive medical services.

Report fraud, waste or abuse

If you suspect fraud, waste or abuse, you can report your concern.

We appreciate your vigilance in helping protect the integrity of healthcare benefit programs. By identifying and reporting fraud, waste, and abuse, you help ensure healthcare resources are used appropriately to support the care and health outcomes of our members.

Learn more about fraud, waste and abuse at https://www.cms.gov/fraud.