The OIG (Office of Inspector General) has provided compliance program Guidance for Individual and Small Group Physician Practices. The OIG needs to investigate for any suspected healthcare Fraud or Abuse. The Term “Fraud” is affixed when a physician purposefully bill for services that were not given to the patient. Another example of Fraud is that a physician performed a low-cost service and in its place, the physician is billing for services costing high amount. Fraud is considered whenever the physician willfully attempted and/or executed. It is always an act of intention.
ABUSE: Payment for items or services that are billed by physicians in error that should not be paid by Medicare. The Physician does not have knowledge or awareness about violation.
Examples of Fraud and Abuse: