CMS defines fraud as the intentional deception or misrepresentation that an individual
makes, knowing it to be false and that it could result in some unauthorized benefit
Abuse describes incidents or practices of providers, physicians, or suppliers of
services and equipment which, although not usually fraudulent, are inconsistent
with accepted sound medical, business, or fiscal practices. These practices may,
directly or indirectly, result in unnecessary costs to the Medicare program, improper
payment, or payment for services which fail to meet professionally recognized standards
of care or which are medically unnecessary.
For fraud and abuse prevention and detection, the OIG offers
advisory opinions, alerts
and bulletins, compliance
information, and more at http://www.oig.hhs.gov/fraud.asp.