In Medicare, which of the following is NOT a common form of fraud and abuse?

The correct answer is that implementing a clinical documentation improvement program is not a common form of fraud and abuse in Medicare. In fact, clinical documentation improvement programs are designed to enhance the accuracy and completeness of patient records. They ensure that healthcare providers document patient care accurately, leading to appropriate coding and billing practices. Effective documentation is crucial for compliance and can help prevent fraud and abuse by promoting transparency and accountability in medical billing.

On the other hand, the other choices represent actions that are typically associated with fraudulent activities. For example, billing for services not furnished involves charging for treatments or services that were never rendered, which constitutes a deceptive billing practice. Misrepresenting a diagnosis to justify payment is another fraudulent act, as it distorts the true nature of a patient’s condition to receive unearned payments. Unbundling or exploding charges involves separating services that are typically billed together to maximize reimbursement, which is also considered an unethical and illegal billing practice under Medicare regulations.