What is Fraud and Abuse?
Healthcare fraud is:
- The intentional or deliberate submission or filing of false claims for the purpose of illicit gain;
- Lying about your condition or the types of services provided;
- Cheating by omitting information about your condition, symptoms, or the treatment or services received;
- Stealing.
Abuse is:
- Similar activity, but where intent or deceit can not be established.
Who Commits HealthCare Fraud?
- Individual patients;
- Physicians and other practitioners;
- Pharmacists;
- Nurses;
- Laboratories;
- Billing services;
- Medical equipment suppliers;
- Hospitals;
- Nursing homes;
- Employees of healthcare providers and insurers.
This does not mean that large numbers of healthcare professionals and others involved in the healthcare system are dishonest. The vast majority are honest and ethical and are victimized in the same way that most Americans are victimized.
Some Common Healthcare Fraud Activities
- Claims from phantom or fictitious providers;
- Claims for services or supplies never provided;
- Altering documents used to obtain payment;
