Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment.

• A. True
• B. False
• C. Only if there is misrepresentation
• D. It is the same as fraud

Answer: (A)

In healthcare compliance, abuse covers improper payments that arise when there is no entitlement to pay and there is no intentional misrepresentation to obtain payment. The situation described fits this: there is no legal entitlement for the payment, and the provider did not knowingly misrepresent facts to get paid. That contrasts with fraud, where there is deliberate deception or falsification to secure payments. So this is abuse—improper billing without the intent to deceive.