Table 1.
Errors | “Unjustly obtaining a benefit of any nature by unintentionally breaking a rule” Example: unintentionally billing for a service that has not been rendered |
Abuses | “Unjustly obtaining a benefit of any nature by knowingly stretching a rule or by taking advantage of an absence of rule” Example: knowingly taking and billing a service without medical indication |
Fraud | “Illegally obtaining a benefit of any nature by intentionally breaking a rule” |
Example: intentionally billing for a service that has not been rendered | |
Corruption | “Illegally obtaining a benefit of any nature by abuse of power with third party involvement” Example: intentionally prescribing an ineffective medication to receive a kickback payment from the pharmaceutical manufacturer |