Every day, millions of Americans depend on health care professionals like you for critical care and services. But there's an invisible threat lurking within our health care system.
Fraud, waste and abuse, collectively known as FWA, aren't just regulatory terms. They are real issues that cost billions of dollars each year affecting patient care, trust and your organization's reputation. So what exactly are fraud, waste and abuse and why should you care? Let's break it down clearly. First, fraud. Fraud is intentionally deceiving, concealing or misrepresenting information to obtain unauthorized benefits.
It is deliberate and illegal. Imagine billing Medicare for medical procedures that never actually took place. This is outright fraud and carries severe legal penalties. Next, waste.
Waste involves practices that lead to unnecessary costs due to inefficiencies, poor management or overuse of services. Waste isn't always intentional, but it still drains valuable resource. For example, repeatedly ordering unnecessary medical tests. This might not be illegal, but it increases costs and reduces available resources for genuine patient care.
Lastly, abuse. Abuse refers to practices inconsistent with sound medical or business practices. Unlike fraud, abuse might lack clear intent but still results in unnecessary health care costs. Consider a clinic regularly using billing codes that exaggerate the complexity of patient visits.
They might not realize they're breaking rules but this practice is abuse and can lead to serious penalties. Now you might wonder why is understanding FWA important to me? It's because every instance of fraud, waste or abuse negatively impacts patient care. It inflates health care costs and puts your organization at risk.
These issues are so critical that multiple federal agencies, the Centers for Medicare and Medicaid Services or CMS, the Department of Justice or DOJ and the Health and Human Services Office of Inspector General or OIG actively enforce compliance. As health care employees, you're on the front lines. You have the power and the responsibility to detect and prevent fraud, waste and abuse. By staying vigilant, understanding your roles clearly and acting with integrity, you protect not just your organization, but also the millions of patients who rely on us every day.
In our next video, we'll dive deeper into the key laws that you must understand and how compliance directly impacts your daily activities. Remember, awareness and prevention begin with you.
Thank you for joining Accountable's FWA training series. Stay alert, stay compliant, and stay accountable. We'll see you next time.
