What is the difference between Health Care Fraud and Health Care Abuse?
The difference between fraud and abuse is the intent behind the action. Fraud is intentional deception or misrepresentation with knowledge that the information is false. Abuse involves actions that are inconsistent with sound fiscal, business or accepted behavioral health care practices and result in an unnecessary cost or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. Abuse can result in the same process impediments and unnecessary cost of care as fraud.
