Fraud
Intentional deception with the intent to obtain illegal financial gain.
*Examples of fraud in medical practice include:*
- Billing for services that were not provided
- Charging for more expensive services than were actually performed
- Submitting false or inflated claims to insurance companies
- Falsifying medical records
- Selling or trading patient information
- Kickbacks or bribes in exchange for referrals or prescriptions
Abuse
Improper or excessive use or utilization of resources
*Examples of abuse in medical practice include:*
- Overprescribing medication
- Unnecessary medical tests
- Performing procedures without a valid medical reason
- Overusing medical equipment or supplies
- Waiving co-payments or deductibles
- Excessive or unnecessary patient visits
Fraud and abuse can both have serious consequences for patients and healthcare providers. Patients may be charged for unnecessary or excessive services, and they may also be put at risk for harm if they are given unnecessary or inappropriate medical care. Healthcare providers may face criminal charges, fines, and/or loss of their licenses.
If you suspect fraud or abuse is taking place in a healthcare setting, you can report it to the appropriate authorities, such as the state medical board or the federal Office of the Inspector General.