What does "fraud, waste, and abuse" encompass in healthcare compliance?

The concept of "fraud, waste, and abuse" in healthcare compliance specifically refers to actions that result in unnecessary costs to healthcare programs and often involve violations of regulatory standards. This encompasses a range of dishonest or negligent behaviors that can lead to financial losses for healthcare programs, such as excessive billing, misrepresentation of services, or providing services that are not medically necessary.

In this context, fraud refers to intentional deceit or misrepresentation for financial gain, waste denotes the overuse or misuse of resources that lead to inefficiencies, and abuse refers to practices that are inconsistent with sound fiscal, business, or medical practices, often resulting in unnecessary costs. Each of these components directly relates to how programs are managed and can impact the integrity of healthcare funding.

The other options do not accurately capture the essence of fraud, waste, and abuse in the realm of healthcare compliance. Actions that reduce overall spending, improve patient care, or promote transparency are generally positive measures that do not align with the negative implications associated with fraud, waste, and abuse.