As someone who’s spent decades helping Texans make sense of health insurance, I know how crucial it is to spot fraud before it impacts your care or your wallet. Fraud in healthcare isn’t just about billing for services that never happened or using someone else’s insurance—sometimes it’s about subtle falsification of records tied to claims. According to a leading anti-fraud group, these deceptive practices siphon off about 3% of all US healthcare spending. That’s over $10 billion every year—money that should be helping with real care, prescriptions, and support.
But there’s more: waste comes from unnecessary or inefficient services, while abuse happens when billing or care doesn’t meet accepted standards—sometimes just to make things look busier than they really are. Health plans fight back by analyzing data, reviewing claims, conducting interviews and site visits, checking providers, and making sure everyone is properly credentialed.
For individuals and families, a little vigilance goes a long way. Review your Explanation of Benefits, keep your insurance info secure, ask questions if something seems off, and speak up if you spot a concern. Protecting your access to legitimate care—and the resources that make it possible—starts with being informed. That’s always been my focus: helping you understand your options and make confident choices about your health coverage.