Insurance fraud entails intentional deception for financial gain, while insurance abuse involves overuse or misuse of services.
Insurance fraud involves intentional deception or misrepresentation for financial gain. Examples include falsifying medical records to show unnecessary procedures, submitting bills for services not rendered, and enticing patients with waived co-payments. On the other hand, insurance abuse involves overuse or misuse of services, such as ordering excessive tests for higher reimbursement or unprofessional billing practices leading to unnecessary payments.
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