The majority of fraud and abuse violations are related to which of the following?

The majority of fraud and abuse violations are primarily related to billing issues. This is because billing is the point at which healthcare providers seek reimbursement for services rendered to patients, and it is here that inaccuracies can easily lead to fraudulent activities. Such violations can include upcoding, where providers bill for more expensive services than were actually delivered, or unbundling, which involves billing separately for services that should be included in a comprehensive charge.

Billing-related fraud and abuse can also encompass submitting claims for services that were never provided, or misrepresenting the nature of the services in order to receive higher payments. Given the complex nature of healthcare billing and coding, there are numerous opportunities for discrepancies that might be considered fraudulent or abusive.

While treatment, diagnosis, and scheduling are important components of healthcare delivery, they generally are not the primary focus of fraud and abuse investigations. Typically, it's the billing process that is scrutinized and often found to contain errors or intentional misrepresentations leading to violations. Thus, understanding the role of billing in these scenarios is essential for compliance professionals and helps frame their efforts in mitigating fraud and abuse within the healthcare system.