Annually, fraud and abuse costs healthcare programs a lot of money. In health care, fraud takes place when a business or an individual deliberately misrepresents facts to get reimbursement for healthcare supplies or services. Fraud criminal offense under federal as well as state laws and may result in substantial fines, health care coverage loss, and penal sanctions, besides jail time. On the other hand, abuse describes practices or incidents conflicting the accepted and sound business, fiscal, or medical practices.
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The key learning objective from the examples is that fraud consume valuable resources that could have otherwise been used by needy beneficiaries of Medicare. In addition, fraud and abuse in the health setting have very dire consequences for offenders.