Fraud and Abuse in Medical Billing
Fraud and abuse in medical billing refer to illegal practices that result in unauthorized payments or overpayments from insurance companies or government programs.
Fraud and Abuse in Medical Billing Explained
In medical billing, fraud involves deliberate actions, such as billing for services not provided, while abuse involves practices that lead to unnecessary costs, such as upcoding or providing unnecessary services. Both can result in penalties, fines, and legal action.
For example, a provider who bills for a service they did not perform is committing billing fraud, while a provider who consistently bills for more expensive services than necessary is committing abuse.
Learn more about common acronyms and abbreviations in Medical billing glossary.
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