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. Not specified
• D. Depends

Answer: (B)

Abuse is about improper billing practices that violate accepted medical or business standards and can drive up costs, but it does not depend on there being no entitlement to payment, nor does it hinge on the provider intentionally misrepresenting facts. Fraud requires intentional deception to obtain payment. So the statement is not correct: abusive billing can occur even when there is some entitlement, and abuse does not require a lack of misrepresentation (though if there is misrepresentation, that would be fraud).