Fraud knowingly misleads or misrepresents information that someone knows is false (or does not think they are true) in order to obtain unwarranted benefits for themselves or another person. Abuses include incidents or practices by suppliers that are inconsistent with accepted sound, commercial or tax practices. These practices may, directly or indirectly, result in unnecessary costs to the program, improper payment or payment of services that do not meet professionally recognized standards of care or are not medically necessary. Abuse involves the payment of goods or services where there is no legal right to payment and the supplier has not knowingly misrepresered the facts in order to obtain payment. The most common type of fraud involves Claims or payments under the Medicare program.


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