Question

provide in 200 words Discuss the differences between fraud and abuse. And provide examples of each and explain how healthcare managers might deal with them in some kind of way.

Answer 1

#. Difference between fraud and abuse :-

Fraud—intentional wrongful or criminal deception intended to result in financial or personal gain; type of abuse; theres a pattern of problems that continue

Abuse—intentional or not intentional improper use of something.

Examples of fraud :-

misrepresenting diagnosis or CPT/HCPCS codes, kickbacks, unbundling services, falsifying medical necessity, systematic waiver of co-payment or deductible.

Examples of abuse :-

mistreatment of patients

#. Healthcare managers can deal with fraud and abuse by the following ways :-

Understand Health Care Laws and Regulations.

Ensure Accurate Billing.

Maintain Updated and Proper Documentation.

Avoid Unnecessary Referrals.

Maintain Physician-Industry Transparency.

Disclose conflict of interest

Carryout and follow compliance plan