What term refers to billing for services that are not covered by insurance?

The term that specifically refers to billing for services that are not covered by insurance is fraud. Fraud in the context of healthcare involves intentionally misrepresenting or falsifying information in order to receive payment for services that were never provided or that are not eligible for reimbursement under a patient's insurance plan. This includes practices such as upcoding or billing for more expensive services than what was actually rendered.

Understanding the distinction among the various terms is essential. While waste refers to the over-utilization of services that result in unnecessary costs, it does not imply intent to deceive. Abuse involves practices that may not necessarily be fraudulent but are inconsistent with accepted sound medical, business, or fiscal practices, and which may lead to unnecessary costs. Overcoding, on the other hand, is a specific practice where a provider bills for a higher level of service than what was actually performed, which can be a result of either intent (fraud) or a misunderstanding of coding guidelines.

Thus, within the realm of compliance and healthcare billing, fraud is the term that accurately characterizes the deliberate act of billing for services that lack coverage under an insurance policy.