SynthesisFrontiers in public health2026
Economic impact of health insurance fraud, waste, and abuse: a literature review of direct and indirect costs and system sustainability.
Synthesis in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Purpose: This study examines the economic impact of fraud, waste, and abuse (FWA) in health insurance systems and synthesizes evidence on governance, legislative, regulatory, and technology-based interventions aimed at improving financial sustainability. It further evaluates the implications of these interventions for healthcare system resilience and identifies research gaps to inform future policy and practice. Method: This study employed a systematic literature search followed by a narrative synthesis to examine the economic impact of health insurance FWA. A comprehensive search of Scopus, Web of Science, MEDLINE, Embase, PubMed, OpenAlex, and Dimensions was conducted for studies published up to 24 November 2025, complemented by backward and forward citation tracking using the Inciteful.xyz platform. Following screening and eligibility assessment, 30 studies were included in the final narrative synthesis. Results: The findings indicate that FWA imposes substantial direct and indirect economic costs on health insurance systems by increasing financial losses, reducing operational efficiency, weakening accountability, and threatening long-term fund sustainability. Evidence suggests that effective mitigation requires an integrated approach combining preventive monitoring, robust governance, legislative enforcement, whistleblower protections, and advanced analytical technologies. Artificial intelligence, machine learning, blockchain, and automated auditing systems demonstrated promising performance in improving fraud detection under experimental conditions; however, evidence supporting their effectiveness in large-scale operational healthcare settings remains limited, and implementation challenges related to scalability, interoperability, privacy, and governance should be considered. Publication trends indicate increasing international research interest in FWA, although evidence remains concentrated in a limited number of countries.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.