| Abuse |
Abuse is the unintentional deception or misrepresentation of an act knowingly made by an individual or entity where such act results in a benefit to the individual or entity. Source: CMS |
| Errors |
Errors include billing and information submitted incorrectly that result in an over or underpayment. Errors also include data entry errors by MCO causing an alteration in the payment of the claim. Source: CMS |
| Fraud |
The intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s). Source: CMS Glossary, 2006 |
| Waste |
Waste is defined as billing and information submitted for items or services where there was no intent to deceive or misrepresent, but the outcome resulted in an overpayment of funds. Source: CMS |