Fraud Mission

2. Submitting separate bills for individual components of a procedure to inflate the total cost.
4. Billing for a treatment never rendered
6. What an insurer does to a claim that looks fraudulent.
7. The illegal exchange of money or services in return for referring patients to a specific healthcare provider.
9. Bill submitted to insurance company for payment
11. Refers to practices that are inconsistent with accepted sound fiscal, business, or medical practices, resulting in unnecessary costs or improper payments.
14. An insider or employee who reports illegal or fraudulent billing practices happening within an organization.
15. an intentional act of deception or misrepresentation made to secure an unauthorized benefit or payment
16. The Administrative branch within the Department of Health and Human Services that is responsible for Medicare and Medicaid Services .
17. Enforcement arm of CMS whose mandate is to fight waste, fraud, and abuse

1. the careless overuse, mismanagement, or misuse of healthcare resources, resulting in unnecessary costs.
2. Performing procedures or treatments solely to maximize reimbursement, rather than for patient care.
3. The law known as the Physician Self-Referral Law.
5. A formal inspection and review of a provider's medical records and billing claims to verify their accuracy.
8. An internal program designed to ensure that all healthcare operations and billing strictly adhere to legal and ethical standards.
9. A five-digit medical code set used to report procedures
10. The federal agency that excludes entities from federal healthcare programs.
12. Billing for a more expensive service or procedure than was actually provided.
13. Document educating patient about insurance payments or denials