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Fraud, waste and abuse (FWA)

Health care fraud affects all of us — from small businesses to corporations, insurers, doctors and members. It impacts the quality of health care and results in higher costs.

Zero-tolerance approach to fraud


Our Special Investigations Unit (SIU) is helping to lead the fight against fraud. How? We investigate all types of fraud. We work to protect you. Your health care costs go down when we reduce fraud, waste and abuse.


What is fraud, waste and abuse?

Fraud happens when someone submits false information to get money or a benefit.


Examples include:


  • Billing for services, procedures, prescriptions and/or supplies that were never provided
  • Knowingly altering claim forms, medical records, or receipts to receive a higher payment
  • Offering treatment while promising you won’t have to pay the balance due after insurance pays

Waste happens when someone overuses health services.


Examples include:


  • Conducting more than needed office visits or writing extra prescriptions
  • Prescribing more medicine than necessary for treating a condition
  • Ordering lab tests

Abuse happens when someone doesn’t follow best medical practices, leading to costs and treatments that aren't needed.


Examples include:


  • Billing for unnecessary medical services
  • Billing for brand name drugs when generics are available
  • Charging extra for services or supplies

Help us by reporting concerns of fraud, waste and abuse.

If you see something suspicious on your plan statement, call us at the number on your ID card.

You can also call our hotline at 1-800-338-6361 ${tty} or email our Special Investigations Unit.

To report your concerns anonymously contact the CVS Health EthicsLine

Questions about your benefits? We speak your language.

We also have free interpreter services to answer questions you may have about our health or drug plan.

Get help from an interpreter

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Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

Also of interest: