FOR IMMEDIATE RELEASE:
October 26, 2026
The Alliance for Health Policy Releases New Reports and Policymaker Resource to Guide Education on Fraud, Waste, and Abuse
– Insights report draws on expert interviews to shed light on the trends, structures, and fundamental questions shaping fraud, waste, and abuse policy
– Seminar report reflects recommendations from more than 50 thought leaders and introduces a question-based educational resource to help policymakers ask, “Is it fraud, waste, or abuse?”
Washington, D.C. — The Alliance for Health Policy today released two companion reports from its 2026 Signature Seminar on Fraud, Waste, and Abuse Policy, a topic drawing renewed attention in U.S. health policy and one that remains inconsistently understood across the policy community. The reports reflect outputs from a two-part program that combined in-depth stakeholder listening with expert-led workshops.
The reports include:
- Insights Report: Draws on 20 in-depth interviews with experts representing a broad range of perspectives, including providers, payers, researchers, policy experts, state Medicaid officials, enforcement and oversight professionals, employers, and patient communities. This report uses a systems-thinking “iceberg” framework to show how the issues most visible in policy debates are shaped by deeper trends, structural dynamics, and foundational questions across the health system.
- Seminar Report: A summary of findings and recommendations from two workshops held in August and September 2026 convening more than 50 health policy experts and stakeholders to discuss critical issues and knowledge gaps in fraud, waste, and abuse policy. The report includes a new educational resource for policymakers.
“Fraud, waste, and abuse is often discussed as a single problem, but the experts we heard from were clear that it is really several, each with its own causes, evidence, and responses,” said Claire Sheahan, M.Sc., President and CEO of the Alliance for Health Policy. “Perspectives differed on the greatest risks and how to balance program integrity with access to care and administrative burden. But there was broad agreement on where education is needed: understanding that intent is what separates fraud from waste, abuse, and simple error, and giving policymakers a shared vocabulary and a clear view of the safeguards already in place. Experts also highlighted opportunities to overcome barriers to better coordination. By starting with deep listening and then convening experts across sectors, these reports help the Alliance offer a more complete picture of the issue than any single stakeholder point of view could provide.”
The Insights Report draws on in-depth interviews conducted from May through July 2026. At the tip of the iceberg, interviewees noted that the areas currently garnering the most attention were high-visibility fraud cases, vocabulary conflation, Medicaid program integrity following recent federal legislation, the current enforcement moment, and scrutiny of the Medicare Advantage business model. In the remaining categories, they noted that the areas of the greatest attention were not always aligned with those of the highest impact, and shared insights on the trends, structures, and fundamental questions that were most important. These insights helped shape the focus of the Seminar workshops.
The Seminar Report, which summarizes the two facilitated workshops, focuses on clarifying what policymakers most need to understand about fraud, waste, and abuse policy. In the first workshop, participants co-designed a congressional curriculum, defining learning outcomes, foundational to advanced content, case studies, and resources. In the second workshop, participants imagined what success would look like in 2036 if policymakers consistently understood the difference between fraud, waste, and abuse, then worked through case studies based on real-life scenarios to identify the questions experts ask before reaching a conclusion.
One key output from the second workshop is a new educational resource built around key questions policymakers can ask to think through whether a situation is likely fraud, waste, abuse, or none of these.
Together, the reports conclude the “Incubate” phase of the Alliance’s two-part program lifecycle. During this phase, the Alliance draws on structured listening with its network of health policy experts. The findings from the 2026 Signature Seminar on Fraud, Waste, and Abuse Policy will directly inform the Alliance’s future nonpartisan educational offerings for congressional staff and the broader health policy community (the “Educate” phase).
The Signature Seminar program was sponsored by AHIP and Cotiviti, whose support made this effort possible. This program lays the groundwork for the Alliance’s educational work on this topic.
The Alliance now seeks partners to continue developing timely, expert-driven educational programming on fraud, waste, and abuse policy for policymakers and the broader health policy community, building on the insights and recommendations surfaced through this Signature Seminar. Connect with us about partnering on or sponsoring future educational programming on this topic.
Download the Educational Resource for Policymakers:
About the Alliance for Health Policy
The Alliance for Health Policy is a nonpartisan, nonprofit organization dedicated to helping policymakers and the public better understand health policy, the root of the nation’s health care issues, and the trade-offs posed by various proposals for change. We believe a better health care system begins with a balanced exchange of evidence, experience, and multiple perspectives.
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Director of Production and Development
kappenzeller@allhealthpolicy.org