A Political Guide to Fraud: What the Numbers and Labels Mean
A reference table for distinguishing fraud, improper payments, waste, abuse, allegations, convictions, restitution and settlements.
Improper payment
Waste
Abuse
Amount alleged
Charged / indicted
Convicted
Restitution ordered
Civil settlement
Fraud estimate
| Term | What It Means | What It Does Not Automatically Prove | Question to Ask |
|---|---|---|---|
| Fraud | Obtaining something of value through willful misrepresentation; intent or knowing/reckless falsity matters. | A fraud-risk estimate or suspicious payment does not by itself prove a particular person committed fraud. | Was fraud adjudicated, admitted in a plea, proven at trial, or only alleged? |
| Improper payment | A payment that should not have been made or was made in the wrong amount; certain payments with insufficient documentation are also counted. | It does not automatically mean fraud. Errors and documentation failures can create improper payments. | How much was attributed to fraud versus error, documentation, eligibility or another cause? |
| Waste | Careless, extravagant or purposeless use of government resources; program-specific definitions can vary. | Waste does not automatically establish intentional deception or a crime. | Was this inefficient spending, or is there evidence of intentional deception? |
| Abuse | Improper or unreasonable conduct or misuse of authority/resources; program definitions may be more specific. | Abuse is not automatically criminal fraud. | Which rule or standard defines the conduct as abuse? |
| Amount alleged | A dollar figure asserted by prosecutors or another government authority in an allegation or charging document. | It is not necessarily an adjudicated or actual loss. | Did a court later determine an actual loss amount? |
| Charged / indicted | Prosecutors have formally accused a defendant of violating criminal law. | An indictment is not evidence of guilt and is not a conviction. | What is the current case status—pending, plea, trial verdict, dismissal or sentencing? |
| Convicted | Guilt has been established by a guilty plea or verdict. | A conviction does not mean every dollar alleged at charging was necessarily proven as actual loss. | What offense and loss amount were established in the plea, verdict or sentencing record? |
| Restitution ordered | A court orders a convicted defendant to reimburse victims for qualifying losses caused by the offense. | It does not mean the full amount has actually been collected or returned. | How much was ordered, and how much has actually been recovered? |
| Civil settlement | Civil allegations or claims are resolved by agreement, often involving payment and other terms. | A settlement is not automatically a criminal conviction or admission of liability. | Does the agreement contain an admission, denial, or no-admission clause? |
| Fraud estimate | A statistical estimate of probable fraud loss across a program or government activity. | It does not mean every estimated dollar has been individually detected, charged or adjudicated. | What methodology, confidence range and programs were included? |
Notes
Definitions are simplified for public understanding and should be read with the cited source material. Exact legal definitions can vary by statute and program.
Sources
[179]U.S. Government Accountability Office
Improper Payments: Agency Actions Needed to Help Save Taxpayer Dollars
[180]U.S. Government Accountability Office
Federal Employees Health Benefits Program: OPM Should Take Timely Action to Mitigate Persistent Fraud Risks
[181]U.S. Government Accountability Office
Improper Payments: Key Concepts and Information on Programs with High Rates or Lacking Estimates
[182]Centers for Medicare & Medicaid Services
Fraud, Waste, and Abuse Toolkit
[183]U.S. Department of Justice
Justice Department Indictment Disclaimer: Indictment Is an Allegation, Not Evidence of Guilt
[185]U.S. Department of Justice
Settlement Agreement — Independent Health and DxID