Healthcare fraud is a significant issue, with intentional deception—like billing for services never received, using someone else’s insurance, or falsifying records—costing the US more than $10 billion annually. That’s about 3% of all healthcare spending, according to anti-fraud experts, and it directly impacts the resources available for essential care, prescriptions, and support. There’s also waste, such as unnecessary or inefficient services, and abuse, which involves practices that don’t align with accepted standards and may exaggerate how often care is provided. Health plans combat these threats using a mix of data analysis, claims reviews, site visits, and provider credentialing to uncover patterns that don’t add up. Reviewing your Explanation of Benefits, safeguarding your insurance details, and speaking up if something seems off are practical ways to protect your access to genuine care and ensure healthcare resources remain available when truly needed.
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