What does the term "fraud" specifically refer to in healthcare?

The term "fraud" in healthcare specifically refers to deceptive practices that are intended to lead to financial gain. This can encompass various activities, such as billing for services not rendered, falsifying patient records, or providing unnecessary medical services for the purpose of charging insurance companies or patients. Fraud undermines the integrity of the healthcare system and can lead to significant legal repercussions for those involved. It is characterized by intentional deceit with the goal of financial benefit, distinguishing it from other issues like negligence or ethical breaches, which may not involve deception for profit. Understanding this definition is crucial for recognizing the serious implications of fraudulent behavior within the healthcare industry.