Covers practices that are inconsistent with sound fiscal, business or medical practices, resulting in unnecessary costs and proper payment or payment for services that failed to me professional standards of care, or that are medically unnecessary

Question

Covers practices that are inconsistent with sound fiscal, business or medical practices, resulting in unnecessary costs and proper payment or payment for services that failed to me professional standards of care, or that are medically unnecessary

Waste
Abuse
Fraud

Answer 1

Waste refers to practices that result in unnecessary costs or inefficient use of resources. It can include things such as unnecessary tests or procedures, over-prescribing medications, or excessive administrative expenses.

Abuse refers to practices that are inconsistent with sound business or medical practices and result in improper payment. This can include billing for services that were not provided, billing for services that are not medically necessary, or upcoding (billing for a higher level of service than actually provided).

Fraud refers to intentional deception or misrepresentation for personal gain. This can include things such as submitting false claims, forging medical records, or billing for services that were not provided.

All three of these practices can contribute to healthcare costs and undermine the integrity of the healthcare system. They are important to address and combat in order to prevent unnecessary spending, protect patients, and maintain the financial sustainability of healthcare programs.