Abuse involves incidents or practices that are not medically necessary as defined by Medicare guidelines or are inconsistent with accepted sound medical, business, or fiscal practices. Abuse can be identified when individuals unintentially follow practices that result in unnecessary Medicare program costs. Abusive practices may develop into fraud and be prosecuted as such.

Examples of abuse include:

• Unbundling charges
• Claims for services not medically necessary (to the extent furnished)
• Incorrectly apportioning costs on cost reports
• Violation of the Medicare Participation agreement
• Routine waiver of coinsurance and deductibles
• Improper or sloppy billing practices