Certified Professional in Health Care Risk Management (CPHRM) 2025 – 400 Free Practice Questions to Pass the Exam

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What does abuse in healthcare generally refer to?

Deliberate fraud to claim reimbursement

Reckless and inconsistent medical practices

Abuse in healthcare generally refers to practices that result in unnecessary costs or that are inconsistent with sound medical practices. This includes actions that may not be intentional fraud but are nonetheless harmful, such as providing substandard care, over-utilizing services, or utilizing services in a manner that is not in accordance with professional recognized standards.

Reckless and inconsistent medical practices can lead to patient harm and can drive up healthcare costs unnecessarily. This aligns with the definitions and regulations established by authorities in healthcare, which seek to protect patient welfare and ensure that resources are used effectively and judiciously. Therefore, the correct recognition of abuse encompasses those practices that compromise the integrity of healthcare delivery beyond minor errors or misinterpretations.

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Minor errors in billing procedures

Misinterpretation of medical coding

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