White Pager: Addressing Fraud, Waste, and Abuse in Managed Care Plans

Managed Care and Medicare Advantage plans are vital to the U.S. healthcare system, but they face persistent challenges with fraud, waste, and abuse (FWA), which threaten the integrity and sustainability of public health programs. FWA leads to billions in improper payments annually, undermining trust and diverting resources from patient care. This white paper by J29, Inc. highlights the urgency of addressing FWA through coordinated efforts among federal agencies, health plans, providers, and technology partners. It recommends a multi-pronged approach combining advanced analytics, human expertise, provider education, robust auditing, and transparent oversight-especially as CMS expands its audit activities. By leveraging innovation and collaboration, stakeholders can protect taxpayer dollars and ensure healthcare funds are used to deliver quality care to beneficiaries. Read more below!