Question

review question 3

select the correct answer.

a physician regularly bills medicare x-rays never provided to beneficiaries. this is considered medicare ______.

a. mistakes
b. inefficiencies
c. abuse
d. fraud

Explanation:

Analyze the scenario

The scenario describes a physician who "regularly bills Medicare X-rays never provided to beneficiaries."

Distinguish between fraud and abuse

Billing for services, procedures, or supplies that were never actually provided or performed is a knowing, intentional misrepresentation to obtain payment, which constitutes Medicare Fraud.

Evaluate the options

• A. Mistakes: Incorrect, as regular billing for unprovided services indicates intent rather than an accidental error.
• B. Inefficiencies: Incorrect, as this is a deliberate illegal billing practice, not an operational delay or waste.
• C. Abuse: Incorrect, as abuse typically involves practices that are inconsistent with sound medical, business, or fiscal practices resulting in unnecessary costs, whereas billing for completely non-existent services is fraud.
• D. Fraud: Correct, because intentionally billing for services never rendered is the definition of healthcare fraud.

Answer:

• A. Mistakes
• B. Inefficiencies
• C. Abuse
• D. Fraud (Correct answer)