CMS gives great details on the many health care fraud types

Fraud, waste, and abuse pose major risks for the Medicaid program. “Fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.” “Abuse means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.” [1]

Providers who engage in fraud and abuse are subject to sanctions under a number of Federal and State laws. Sanctions under Federal law, for example, can take the form of administrative,[2] civil,[3] and criminal [4] penalties. These penalties range from monetary fines and damages to prison time and exclusion from the Federal health care programs, including Medicaid. Becoming familiar with common types of fraud, waste, and abuse, will better position providers to ensure they are not involved in such conduct. Providers will also be better equipped to identify and report others who may 0be engaged in fraud, waste, and abuse. Read More from Source