Federal healthcare fraud enforcement is having a milestone year: Fiscal-year 2025 produced the largest False Claims Act recoveries in the statute’s history. In addition, the Department of Justice’s June 2026 National Health Care Fraud Takedown charged 455 defendants and included more participating state Medicaid Fraud Control Units than any prior DOJ fraud initiative. Still, published estimates have found that fraud accounts for a modest share of total wasted healthcare spending.
Fraud, waste, and abuse are often presented together and matched with a single response. This paper presents the three components as a triangle, where each side carries its own definition and the corners function as handoffs from one component to the next. It examines the composition of that spending waste, considers why healthcare industry attention concentrates on fraud more than waste and abuse, and describes five practical, evidence-based approaches for reducing waste and abuse in partnership with providers.
Key discussion points include the following:
- Reaching a high-water mark on fraud enforcement: Much attention and producing record recoveries
- Distinguishing the three sides of the triangle: Fraud, waste, and abuse
- Sizing the sides: Estimated annual overspend in U.S. healthcare, and putting enforcement recoveries in perspective of total overspend
- Examining why attention concentrates on the fraud side: How waste and abuse are more difficult to solve
- Looking at hidden costs of a single-sided strategy: How every disputed healthcare claim carries two costs, one inside the payer and one inside the provider
- Strengthening the waste and abuse sides: Five practical levers