These are examples of issues that should be reported to a Compliance Department: suspected fraud, waste, and abuse (FWA); potential health privacy violation; unethical behavior; and employee misconduct.

Waste includes any misuse of resources, such as the overuse of services or other practices that, directly or indirectly, result in unnecessary costs to the Medicare Program.

Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly or intentionally misrepresented facts to obtain payment.

Some of the laws governing Medicare Parts C and D fraud, waste, and abuse (FWA) include the Health Insurance Portability and Accountability Act (HIPAA), the False Claims Act, the Anti-Kickback Statute, and the Health Care Fraud Statute.

You can help prevent fraud, waste, and abuse (FWA) by doing all of the following: look for suspicious activity; conduct yourself in an ethical manner; ensure accurate and timely data and billing; ensure you coordinate with other payers; verify all information provided to you; and keep up to date with FWA policies and procedures, standards of conduct, laws, regulations, and the Centers for Medicare and Medicaid Services (CMS) guidance.

What are some of the penalties for violating fraud, waste, and abuse (FWA) laws?