FWA is an acronym for “Fraud, Waste and Abuse,” a crime you — either as a patient or a provider — may knowingly or unwittingly commit. If the state or federal government charges you with either crime, you may wonder what, exactly the charges entail.

The Centers for Medicare and Medicaid Services defines fraud, waste and abuse so that health care professionals can know how to identify it and, just as importantly, how to combat it. If you face criminal charges, it may be worth your while to understand the elements of each crime.

Medicare fraud

Medicare fraud costs the U.S. taxpayers billions of dollars each year. Because of this, the government considers it a very serious crime, and one that comes with a penalty of up to $250,000 in fines and 10 years in prison.

Medicare fraud refers to the crime of willfully and knowingly executing, or attempting to execute, a scheme designed to defraud a government health care benefit program. You may also commit health care fraud by obtaining, or attempting to obtain, money or property that a health care benefit program owns or has control over, through false or fraudulent means.

Medicare waste and abuse

Waste entails overusing Medicare services and, therefore, causing the Medicare Program to accrue unnecessary costs. Though not necessarily caused by criminal negligence, the government does frown upon it and may intervene if it feels you misuse resources.

Like waste, abuse also results in increased and unnecessary costs for the Medicare Program. Abuse can occur directly or indirectly and happens when a patient or provider asks the program to pay for items or services to which the patient or provider has no legal right. Abuse differs from fraud in that the accused did not intentionally or knowingly misrepresent the facts to obtain payment.

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