Which statement best defines Abuse?

• A. Intentional deception or misrepresentation to gain a benefit to which they are not entitled.
• B. Payment for items or services that the provider is not entitled to and for which the provider has not intentionally misrepresented facts to obtain payment.
• C. Incurring unnecessary costs as a result of deficient management practices, systems, or controls.
• D. Providing free services to patients as pro-bono service.

Answer: (B)

Abuse is improper or excessive billing that leads to payments for items or services a provider isn’t entitled to, usually without the intent to deceive. In this scenario, payments are made for services the provider isn’t entitled to, and there was no intentional misrepresentation to obtain payment, which fits abuse. By contrast, intentional deception to obtain payment is fraud; unnecessary costs arising from poor management are waste; providing pro-bono services is legitimate and not considered abuse.