BUSI311 DB8.docx - According to a fundamental definition ...

According to a fundamental definition, abuse is comprised of incorrect activities that are
inadvertent yet conflicting with accepted procedures, whereas fraud is a purposeful act of
deception (Buchbinder & Shanks, 2017). Healthcare fraud is the deliberate misleading of a
person for their own or another's advantage. The motivation behind the action is what
distinguishes fraud from abuse. The same obstacles and excessive expenditures associated with
the action can be a result of both fraud and misuse. The most frequent instances of healthcare
fraud include billing for services that were not provided, billing for more expensive services,
performing medically unnecessary procedures to obtain insurance payments, fabricating patient
diagnoses to support tests, accepting kickbacks for patient deferrals, waiving co-payments, and
billing insurance companies. These behaviors may lead to harsh financial penalties or criminal
charges.