Fraud or Abuse?

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