What is fraud, waste and abuse?

Fraud, waste and abuse (FWA) is the umbrella term payers and regulators use for improper billing and practices. Fraud is intentional deception, such as billing trips that never happened or upcoding ambulatory trips as wheelchair. Waste is overuse or inefficiency, such as inflated mileage. Abuse is conduct inconsistent with sound practice that results in unnecessary cost, such as transporting riders who could use other means. Medicaid NEMT has a history of FWA cases and is a standing audit priority.

Why FWA matters for NEMT

State Medicaid Fraud Control Units and broker program-integrity teams actively investigate NEMT. Honest providers protect themselves with GPS-verified trips, signature capture, mileage tied to mapping, driver training on documentation, and an internal audit of a sample of trips each month. Read audit risks in NEMT billing for the patterns that trigger reviews.

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