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Identify which of the following are examples of insurance fraud and which are examples of insurance abuse:

A. New patients are pursued with the enticement of waived co-payments.
B. Bills are submitted to insurance for patients who missed their appointment.
C. Medical records are falsified to indicate that a procedure is medically necessary.
D. Unprofessional or problematic billing practices result in unnecessary insurance reimbursement.
E. Excessive use of health care services (e.g., ordering multiple tests to receive higher reimbursement).



Answer :

GinnyAnswer

Final answer:

Insurance fraud entails intentional deception for financial gain, while insurance abuse involves overuse or misuse of services.


Explanation:

Insurance fraud involves intentional deception or misrepresentation for financial gain. Examples include falsifying medical records to show unnecessary procedures, submitting bills for services not rendered, and enticing patients with waived co-payments. On the other hand, insurance abuse involves overuse or misuse of services, such as ordering excessive tests for higher reimbursement or unprofessional billing practices leading to unnecessary payments.


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