Question

Differentiation between Fraud and Abuse? Explain

Answer 1

Fraud and abuse both are the major threats in the healthcare system.

The Centers for Medicare & Medicaid Services explains these in detail and consider it as the offense.

Fraud is the misrepresentation of the services may in wrong or unauthorized way.

Abuse may be the case of the fiscal practices.

The outcomes are the same and create the fraudulent situation.

In case of the fraud the government consider the federal criminal conviction and immediately take some administrative action,

but the abuse is considered as the lesser offense as there is violence of the coding and billing guidelines, causing errors and government impose some fine in this case to recover the same..