Breaches in the assignment of benefits are described as what?

• A. Fraud
• B. Neglect
• C. Abuse
• D. Compliance

Answer: (C)

Breaches in the assignment of benefits are described as abuse because they involve improper use of the benefits process that can lead to payments that aren’t properly justified. When a patient assigns benefits, they’re designating who should receive payment from the insurer. If this arrangement is breached, a provider may bill in ways that aren’t aligned with accepted billing practices—overbilling, billing for services not performed, or misrepresenting benefits—to obtain more funds. These actions are improper and fall under abuse: they reflect questionable billing practices or other improper use of the benefits process, even if there isn’t explicit intent to commit fraud.

Fraud requires intentional deception to obtain money improperly, which is a higher bar than abuse. Neglect is about failing to provide required care, and compliance is behaving according to rules. So the correct concept here is abuse.