Abuse [Healthcare Compliance Tips]

Post the definition of abuse and share examples with your team.

Now that we talked about fraud in our previous tip, let’s go into the definition of what constitutes abuse.

Medicare describes abuse as:

 “Practices that either directly and indirectly, result in unnecessary costs.” 

Abuse is also further described as:

“Includes any practice not consistent with providing patients with services that are medically necessary, meet professionally recognized standards, and are priced fairly.”  

What does abuse look like?  The following are examples of abuse:

• Billing for unnecessary medical services.
• Charging excessively for services or supplies.
• Misusing codes on a claim, such as upcoding or unbundling codes.
• Billing for services not properly documented.
• Practice fails in maintaining proper medical or financial records.

To avoid abusive practices, we suggest that you create an effective compliance program to catch errors, in which internal audits, training, and monitoring should be performed at least annually (if not monthly or quarterly).

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify, and tailor the advice to fit your specialty.