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ACCORDING TO the Centers for Medicare & Medicaid Services (CMS), the National Health Expenditure Data (NHE) grew 9.7% to $4.1 trillion in 2020, or $12,530 per person. This accounted for 19.7% of Gross Domestic Product (GDP). During this same period, hospital expenditures grew 6.4% to $1.2 trillion, and prescription drug spending rose 3% to $348.4 trillion. Healthcare has the highest volume of claims and payouts per any line of insurance, and arguably the most complex coverage determination guidelines. It’s no wonder healthcare fraud, waste, and abuse (FWA), (or improper payments), is a massive issue costing US health plans billions of dollars each year.

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