HCAFA Practice Questions - AHIP Health Care Anti-Fraud Associate (HCAFA) Designation Exam

Which element distinguishes health care fraud from waste or abuse under the NHCAA definition?

Intentional deception or misrepresentation knowing it could result in an unauthorized benefit Any billing error that causes financial loss to a payer Provision of services that are medically unnecessary but billed correctly Overutilization of services without any misrepresentation

Correct Answer:

Intentional deception or misrepresentation knowing it could result in an unauthorized benefit

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