Eliminating Fraud and Abuse

Rwjf.org: July 31, 2012

At a time of high federal budget deficits and unsustainable growth in health care costs, there is general agreement on the need to eliminate unnecessary spending in health care—and among the leading candidates are fraud and abuse. Despite ongoing, concerted efforts, making meaningful inroads has not been easy. “Fraud” refers to illegal activities in which someone gets something of value without having to pay for it or earn it, such as kickbacks or billing for services that were not provided. “Abuse” occurs when a provider or supplier bends rules or doesn’t follow good medical practices, resulting in unnecessary costs or improper payments. Examples include the overuse of services or the providing of unnecessary tests. (Another area, “waste,” refers to health care that is not effective, and will be the subject of a separate Health Policy Brief.) Read more