Now after hearing the OIG disclaimer in our previous tip, let’s go further into the definition of fraud.
According to Medicare, fraud is defined as:
What does fraud look like? The following are some common examples of what is considered fraudulent activity:
I shared the definitions and examples directly from Medicare’s website to show how important it is as professionals that we understand that one definition does not encompass fraud. There are many aspects that the government reviews to see if the investigation will hold up before calling it fraud.
Per the OIG, the difference between fraud and abuse is the individual’s intent; however, both have the same impact because they steal valuable resources from the healthcare industry.
Practices also run the risk of appearing on the exclusion list due to fraudulent activity or worse losing their professional licenses.
In the next tips, we will discuss abuse. Click the arrow button below to see the next tip.
**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.