Fraud or Abuse?
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A pattern of submitting insurance claims for services which were not medically necessary.
Abuse
Failure to maintain accurate medical or financial records
Abuse
When doctors or supplies directly or indirectly do not follow good medical practices which may result in unnecessary costs to the health care benefit programs, inappropriate reimbursement, or services that are not medically necessary
Abuse
Billing for services or supplies that the patient never received (a criminal offense under BOTH state and federal laws)
Fraud
Falsifying insurance eligibility
Fraud
Submitting claims for services not provided or used.
Fraud
Using another person's insurance card or subscriber number, or allowing someone to use yours.
Fraud
