MedCity News January 24, 2022
Subrahmanyam Mantha

Although telehealth offers many benefits for patients, it introduces operational complexities for providers and creates legitimate concerns about fraud, waste and abuse for payers.

The United States spends an average of $3.8 trillion per year on healthcare. Some estimate that fraud, waste and abuse (FWA) costs the nation at least $114 billion annually — representing more than 3% of overall healthcare spending.

So, what can payers and providers do to reduce the massive amount of overspending? To start, let’s define FWA.

Defining fraud, waste and abuse

Fraud: An intentional deception or misrepresentation to defraud a healthcare benefit program for unauthorized benefit or payment. This involves knowingly, willfully and intentionally making false statements or misrepresenting material facts.

Examples include purposely billing...

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Topics: AI (Artificial Intelligence), Healthcare System, Insurance, Payer, Pricing / Spending, Provider, Technology
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