Fraud, Waste & Abuse: did you know?

  • As a nation, we spend over $2.7 trillion on healthcare every year, and it is estimated that tens of billions are lost each year to FWA.  One recent study estimated that fraud and abuse added as much as $98 billion to annual spending on Medicare and Medicaid. It affects not only the cost but quality of care received.
  • Combating healthcare fraud in Medicare and Medicaid is an important priority for the Federal Government. The Centers for Medicare & Medicaid Services (CMS), the Federal agency responsible for administering these programs, takes its role in leading anti-fraud efforts very seriously and has issued strict requirements for those involved in providing Medicare Advantage and Medicare Part D coverage.
  • The Office of Inspector General, a sister agency to CMS within the U.S. Department of Health and Human Services, is also actively involved in anti-fraud efforts.
  • CMS requires Medicare plan sponsors to provide training in fraud, waste, and abuse (FWA) to their employees involved in Medicare plan work. This training must occur within 90 days of hire and annually thereafter.
  • Insurance agents and brokers as well as employees of agencies and field marketing organizations (FMOs) that are performing services for Medicare plans are required to take the training and pass the exams.
  • Total Benefit Solutions Inc., employees who handle these types of plans take these trainings and certifications annually.


Click on this video to watch a 30 second commercial about Medicare Fraud










Click on this video to watch: Medicare & You-Preventing Fraud