Identified in the quality assurance process

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Reference no: EM133801361

Question

An insurance company breached its Medicare contract by failing to report errors identified in the quality assurance process. It concealed its true error rate by deleting claims selected for review by CMS and replacing them with claim files that would not significantly affect the error rate (and thus preserve its standing within payer performance rankings). Is this situation Fraud or Abuse?

Reference no: EM133801361

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