Billing non-covered or non-chargeable services as covered items is an example of

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

Answer: (A)

The key idea is intentional deception to obtain payment. Billing non-covered or non-chargeable services as if they were covered is a false representation to the payer because you’re claiming reimbursement for items or services that aren’t eligible for coverage. That makes it fraud, since the claim is knowingly misrepresented to secure payment.

It isn’t a permissible billing practice, since only covered services should be billed as such, and there’s no legitimate basis to treat non-covered items as covered. It isn’t a clerical error either, because this scenario involves deliberate coding/claims submission to mislead payers rather than a simple, accidental mistake. While abusive billing can involve questionable patterns that may raise red flags, fraud specifically rests on the element of intentional deception to obtain payment.