Examples of fraud that show intent to defraud include: documenting a service that did not occur, upgrading the physical status, submitting documentation for reimbursement that you know is not correct and creating false documentation to support a higher level of service.
The term abuse means practices that are not consistent with medical, business or financial standards that result in waste of funds for reimbursement. It is usually used in association with fraud.
Some examples of abuse are billing non-covered services as covered services, reporting duplicate charges on a claim, charging excessively for services, and improper billing that results in payment by a government program when another payer is responsible.
It is important to be aware of the rules to prevent claims of Fraud and abuse.