Answer:
Fraud and Abuse
Step-by-step explanation:
Fraud is an intentional deception or misrepresentation of fact that can result in unauthorized benefit or payment and Abuse means actions that are improper, inappropriate, outside acceptable standards of professional conduct or medically unnecessary.
Examples of Fraud
submitting claims for services not provided or used
falsifying claims or medical records
misrepresenting dates, frequency, duration or description of services rendered
billing for services at a higher level than provided or necessary
falsifying eligibility
failing to disclose coverage under other health insurance
Examples of Abuse
a pattern of waiving cost-shares or deductibles
failure to maintain adequate medical or financial records
a pattern of claims for services not medically necessary
refusal to furnish or allow access to medical records
improper billing practices