Available in Adobe pdf format. This means monitoring how doctors, health care suppliers and health care providers bill Medicare. While most providers and suppliers are honest, there are some who misuse the money that supports your health care by defrauding and abusing the Medicare system. Fraud , as defined by HCFA, is an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in the payment of unauthorized benefits. A scheme does not have to be successful to be considered fraudulent.
Abuse involves actions that are inconsistent with sound medical, business, or fiscal practices.
Abuse directly or indirectly results in higher costs to the Medicare program through improper payments that are not medically necessary. The primary difference between fraud and abuse is a person's intent. What To Look For Fraud and abuse can take many forms. Misrepresenting the services rendered. Misrepresenting the diagnosis to justify payment for services.