What does the acronym FWA stand for in CMS terminology?

• A. Fraud, Waste, and Abuse
• B. Financial Wrongdoing and Abuse
• C. Fraud, Waste, and Allegations
• D. Fraud, Waste, and Adverse Actions

Answer: (A)

In CMS terminology, FWA stands for Fraud, Waste, and Abuse.

Fraud involves intentional deception to obtain payment for services not provided or not medically necessary, such as billing for a service you didn’t perform or upcoding the level of service. Waste refers to inefficient or unnecessary practices that lead to unnecessary costs, like poor billing practices or resource mismanagement, even if there’s no intent to defraud. Abuse covers practices that are inconsistent with accepted medical or business standards and result in unnecessary costs or improper payments, such as charging excessively for services or using codes without proper medical necessity.

This triad guides CMS’s program integrity efforts, focusing on preventing and detecting improper payments and safeguarding resources. The other phrasings don’t reflect the standard CMS term set for these categories, which is why they aren’t used in practice.