How are fraudulent claims different from erroneous claims submitted to federal healthcare programs?

Fraudulent claims are characterized by the intent to deceive or misrepresent information in order to gain an unauthorized benefit or payment from federal healthcare programs. This intention to deceive distinguishes fraudulent claims from erroneous claims, which may arise from mistakes or unintentional errors in documentation or billing practices. While both types of claims can be problematic, the key difference lies in the intention behind the submission.

Erroneous claims typically result from human or clerical errors, such as incorrect coding or billing for services not rendered, without any intent to mislead. On the other hand, fraudulent claims are deliberate acts aimed at falsifying information to illegally benefit from federal programs.

In summary, the distinguishing factor for fraudulent claims is the presence of intentional deceit, making them a serious violation of healthcare compliance and ethics. Recognizing this distinction helps protect the integrity of healthcare programs and ensures accountability in healthcare billing practices.