When someone does something wrong and knows it, it is fraud. When someone don’t follow the rules by mistake it is abuse. And when someone spends money or uses things without care, that can be waste.
All three things are bad and can get people in a lot of trouble if caught. This is why it is so important to say something as soon as you see something suspicious.
What is Fraud, Waste, and Abuse?
Here are some examples of Fraud, Waste, and Abuse in healthcare.
By Members:
Someone lying in an application about where they live or how much money they have or make.
Someone giving their Medicaid card to a friend or family member so they can pretend to be that person to go see the doctor.
Someone using the emergency room for services that are not true emergencies. If it is not an emergency, they should see their regular doctor in the doctor’s office.
By Doctors or Medical Companies:
A Doctor ordering many tests or exams you don’t need. If you feel like you don’t need it, say something.
A company billing for a fancy wheelchair, but giving a member a basic wheelchair. If you feel you should have gotten something better, say something!
A Doctor billing us for a visit that never happened or bills us for services that happened on a different day.
