Directions: Read through each scenario and circle whether it is a fraud issue, practice of abuse, or neither. To distinguish the difference between fraud and abuse situations remember that under the Medicare program, abuse relates to incidents or practices that are inconsistent with accepted sound business practices, whereas fraud is intentional deception that an individual knows, or should know, to be false, and the individual knows the deception could result in some unauthorized benefit to himself or herself or to some other person(s). Explain the answer you selected.

Scenario:

Dr. Ulibarri tells the insurance biller not to collect the deductible and copayments from Mrs. Gerry Coleman.