decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Fraud and Abuse / Fraud and abuse definitions
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Article Overview
This premium article gives a high-level overview of how Medicare compliance materials distinguish fraud from abuse, including common examples of problematic billing and documentation behavior and the agencies involved in enforcement. It is useful for physicians, coders, compliance staff, and billing professionals who need a general orientation to fraud-and-abuse terminology and enforcement context.
Why This Topic Matters
Understanding fraud-and-abuse concepts helps practices recognize compliance risk, respond appropriately to audits and reviews, and support internal controls aimed at avoiding administrative actions or prosecutions.
What You Will Learn
- How fraud and abuse are generally differentiated in Medicare compliance materials
- What broad categories of conduct are discussed as examples of abuse or fraud
- Which government entities are referenced in connection with enforcement
- How related compliance topics are framed in the broader Medicare claims environment
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance officers
- Practice administrators
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