BlueCross & BlueShield United of Wisconsin. What is health care fraud?


Fraud involves the intentional deception or misrepresentation that is intended to result in receiving an unauthorized benefit. A common example is billing for services that are not actually rendered. Insurance abuse involves charging for services that are not medically required, do not conform to professionally recognized standards or are overpriced. An example would be performing unnecessary lab tests on a large numbers of patients when only a few actually need it. Abuse is similar to fraud except that it is not possible to establish that the abusive acts were done with the intent to deceive the insurer.

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