AAHAM Certified Revenue Cycle Executive (CRCE) Practice Exam 2025 - Free CRCE Practice Questions and Study Guide

The term that refers to intentional deception for personal gain in a healthcare context is fraud. In the healthcare setting, fraud encompasses activities such as billing for services not provided, falsifying patient records, or deliberately misrepresenting medical necessity to enhance reimbursement. This behavior undermines the integrity of the healthcare system and can lead to significant legal repercussions for both individuals and organizations involved.

While abuse can involve practices that may lead to overstated costs or unnecessary services, it does not necessarily imply intentional deceit. Negligence relates to a failure to provide appropriate care, resulting in harm, and misrepresentation involves incorrect statements or claims that might not be consciously deceptive. Each of these terms has its own distinct definition and implications within healthcare, but fraud specifically identifies actions driven by the intention to deceive for personal or financial gain.