This document discusses fraud and abuse in managed care from the perspective of a managed care organization. It defines fraud and abuse, provides examples of each, and outlines the roles and responsibilities of managed care organizations and providers in preventing, identifying, investigating and reporting potential fraud and abuse. Key responsibilities include managed care organizations developing compliance programs, investigating claims, recovering overpayments, and reporting issues to the proper authorities, while providers must properly document services, self-audit, and cooperate with investigations.