MEDICAL,USA: 1. An intentional misrepresentation of the facts to deceive or mislead another. 2. In a health care setting, the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s). In addition, fraud may be committed by either providers or patients to obtain services, payment for services, or claim program eligibility. 3. In insurance claims, some fraudulent practices are intentionally double billing for the same services, reporting diagnoses and procedures to maximize payments, billing for services that were not performed, altering claim forms for higher reimbursement, soliciting or receiving kickbacks or bribes, using another person’s Medicare card, and falsely representing services provided. 4. Lying or intentional misrepresentation by insurance company managers, employees, agents, or brokers for their own gain.
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Obtaining an advantage by unfair or wrongful mans. Deception or artifice used to deceive or cheat.
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The intentional perversion of the truth in order to mislead someone into parting with something of value. Black’s Law Dictionary, 6th Edition, defines “fraud” as an intentional perversion of the truth for the purpose of inducing another in reliance upon it to part with some valuable thing belonging to him or to surrender a legal right a false representation of a matter of fact, whether by words or by conduct, by false or misleading allegations or by concealment of that which should have been disclosed, which deceives and is intended to deceive another so that he shall act upon it to his legal injury.