Question

7) How is abuse different from fraud? Explain and give an example of each !

Answer 1

7) Difference between Abuse and Fraud

Abuse can be defined as the improper treatment or usage whereas Fraud is the crime of stealing or otherwise illegally obtaining  money by use of deception tactics.

Health care 'abuse ' is the practices or actions or behaviours that are inconsistent to the accepted or generally approved medical, fiscal or business practices. Health care ' Fraud' is an intentional deception or cheating carried out for the purpose of undeserved, unfair and / or unlawful gain by altering medical records, or by billing the services, that are not delivered. Both practices such health care abuse and Fraud can attract negative consequences such ad financial loss. Health care fraud can attract Federal criminal investigation and legal actions. Both practices may results in monetary penalties, even though abuse is considered as a lesser offense.

Examples for Healthcare 'Abuse'

* Different rates for billing services

* overuse health care services by giving multiple appointments for patients to receive higher compensation.

* improper billing practices or patterns that demand for unnecessary compensation or refund .

Examples for Health care ' fraud '

* Identity theft for gaining unlawful compensation from Medicaid or Medicare.

* altering or distorting the Patient's diagnosis for justifying unnecessary medical procedures like surgeries and tests.

* Unnecessary referrals by obtaining a clandestine payment from the other party.

* Billing for services that are never delivered by using false identity, or using genuine patient information.