Billing Medicare for services that should be billed to another insurer is an example of

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

Answer: (C)

Billing Medicare for services that should be billed to another insurer uses Medicare resources inappropriately, making it an abuse. Abuse covers improper billing practices that deviate from accepted, reasonable business practices and can lead to unnecessary costs. When another payer should be primary, the correct process is to bill that insurer first and only bill Medicare if it is appropriate to do so as the payer of last resort. This differs from a clerical error, which would be an accidental mistake, and from fraud, which requires an intent to deceive to obtain payment. So this scenario illustrates abuse because it involves improper billing that could inflate Medicare costs even without proven intent to defraud.