Abuse describes practices that result in unnecessary costs to the Medicare Program. Abuse includes any practice that is not consistent with the goals of providing patients with services that are medically necessary, meet professionally recognized standards, and are priced fairly.
Examples of Medicare abuse include:
- Billing for services that were not medically necessary
- Charging excessively for services or supplies
- Misusing codes on a claim, such as upcoding or unbundling codes
Medicare fraud and abuse exposes healthcare providers to criminal and civil liability.