Billing for medically unnecessary services is an example of

• A. An example of fraud
• B. An example of abuse
• C. A permissible billing practice
• D. A clerical error

Answer: (B)

Billing for medically unnecessary services reflects an improper billing practice that lacks medical justification and drives up payer costs without benefit to the patient. It is categorized as abuse because it involves inappropriate practices within the billing system, even if there isn’t proven intent to deceive. Fraud would require intentional deception or misrepresentation to obtain payment, which goes beyond merely improper billing. A clerical error would be a simple mistake in data entry, not a pattern of improper billing. So, this scenario aligns with abuse.