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Which of the following situations may indicate a false claim? (Select the four that apply.)

A. A physician applies her name to a claim even though she was not in the office and the certified nurse midwife performed the service.

B. A physician performs a service he is not licensed for and bills the patient.

C. The billing system is programmed to insert diagnosis codes on a claim to pass Medicare claim audits.

D. A medical coder does not see appropriate documentation for the codes that were chosen by the physician's office, so he reaches out to the physician for documentation clarification.

E. A medical coder is told to always code a physician's service a certain way, even if there is no documentation of the service in the medical record.


Sagot :

Final answer:

False claims in the medical field can have serious consequences and are considered fraudulent activities. Examples include billing for unperformed services and inaccurate coding.


Explanation:

False claims in the medical field can have serious consequences and are considered fraudulent activities. Examples of situations indicating false claims include a physician billing for a service they are not licensed to perform, a billing system inserting inaccurate codes on claims, coding services without proper documentation, and altering codes against documentation. These actions can lead to financial losses and legal repercussions.


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