Intentional misrepresentation by either providers or consumers to obtain services, obtain payment for services, or claim program eligibility. Fraud may include the receipt of services which are obtained through deliberate misrepresentation of need or eligibility ; providing false information concerning costs or conditions to obtain reimbursement or certification; or churning payment for services which were never delivered or received. Fraud is illegal and carries a penalty when proven.
Obtaining products, services, or reimbursement by intentional false statements. Fraud includes such acts as misrepresenting eligibility or need for services, and claiming reimbursement for services not rendered or for nonexistent patients. Fraud is illegal and may carry civil and criminal penalties. Medicare law specifically prohibits fraud.
The marketing and selling of products or service by making false claims.