Which of the following is NOT included in the definition of fraud by CMS?

Prepare for the Certified Documentation Expert Outpatient Exam with flashcards and multiple choice questions. Each question includes hints and detailed explanations to help you excel. Gain confidence for your exam!

The definition of fraud by the Centers for Medicare and Medicaid Services (CMS) encompasses actions intended to deceive for financial gain. Among the options provided, using accurate patient data does not fit this definition, as it inherently implies honesty and truthfulness in reporting.

In contrast, submitting false claims, misrepresentation to obtain payment, and providing false information are all actions that clearly demonstrate intent to deceive and manipulate billing processes for financial benefit. These activities violate the principles of integrity and accuracy required in healthcare documentation and billing. Therefore, it is crucial to recognize that accurate patient data is not an element of fraud; instead, it serves as a foundation for ethical billing practices.

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