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CMS defines as billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payments from a federal healthcare program, or billing for services that were not preformed?

1) Fraud
2) Abuse
3) A Stark violation
4) An Anti-kickback

1 Answer

2 votes

Final answer:

Billing for a lower level of care than documented, making false statements for payments, or billing for non-performed services constitutes fraud in the healthcare industry.

Step-by-step explanation:

The action described as billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payments from a federal healthcare program, or billing for services that were not performed is known as fraud.

This impacts various healthcare programs including Medicare and Medicaid, which operate under fee-for-service and other healthcare financing systems. Fraud can lead to various penalties and is a serious offense in the healthcare industry.

Fraud is defined as billing for a lower level of care than is supported in documentation, making false statements to obtain undeserved benefits or payments from a federal healthcare program, or billing for services that were not performed.

This behavior is illegal and unethical. It undermines the integrity of the healthcare system and can lead to significant financial loss for the government and patients.

Therefore answer is 1) Fraud.

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