In healthcare fraud and abuse cost billions of dollars each year (RevCycleIntelligence, 2018). Understanding the difference between fraud and abuse is important as well knowing how to avoid either one. Fraud is where a healthcare provider intentionally falsifies information to deceive Medicare. Abuse is where a healthcare provider unintentionally represents information toMedicare (Harrington, 2016 p. 228). It is because of this that there are fraud and abuse laws in place. On a federal level there several laws in place for fraud and abuse. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created to assist in the enforcement of fraud and abuse laws. There is the False Claims Act which can lead to fines up to 3 times the amount the provider billed and imprisonment. An example of this would be a provider filling a claim for services that they knowingly never rendered. Another law is the Anti-Kickback Statute.
- Fall '19