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Cost Containment System

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Examples of Fraud and Abuse

Falsifying Claims / Encounters
Falsifying Services
Alteration of a Claim
Incorrect Coding
Double Billing
False Data Submitted
Billing for Services / Supplies Not Provided
Misrepresentation of Services / Supplies
Substitution of Services
Administrative / Financial
Member Issues (Fraud) Eligibility Determination Issues:
Kickbacks
Falsifying Credentials
Fraudulent Enrollment Practices
Fraudulent Third Party Liability (TPL) Reporting
Fraudulent Recoupment Practices

 

Resource Misrepresentation (Transfer / Hiding )
Residency
Household Composition
Citizenship Status
Unreported Income
Misrepresentation of Medical Condition
Failure to Report Third Party Liability (TPL)

 

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AHCCCS, 801 E. Jefferson, Phoenix, AZ 85034, (602) 417-4000
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This page was last modified on Thursday, September 13, 2007 at 11:52:08 AM
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