Which describes fraud perpetrated by medical practitioners, medical suppliers, or medical institutions on patients or health care programs to increase their own income by illicit means?

• A. Beneficiary fraud
• B. Provider fraud
• C. Uncovered party fraud
• D. Insurer fraud

Answer: (B)

In healthcare, fraud by the people delivering care or supplying medical goods aims to boost their own income through illicit means. That is, doctors, clinics, hospitals, or suppliers manipulate billing or arrangements to take more money than is legitimately due from patients or health programs. Examples include billing for services not performed, upcoding (charging for more complex services than given), unbundling procedures to bill separately, or taking kickbacks to steer referrals or purchases. This focus on the actions of providers distinguishes it from patient-based fraud or payer-driven schemes.

Beneficiary fraud involves patients misrepresenting information to obtain benefits; insurer fraud involves the payer manipulating claims or coverage. The scenario described is thus provider fraud.