Fraud is the “intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. It is estimated that nearly 60 billion dollars are lost annually due to health care fraud and abuse” (McMacken, 2021). Healthcare fraud includes misrepresentation of the type or level of service provided, misrepresentation of the individual rendering service, billing for items and services that have not been rendered, billing for services that have not been properly documented, billing for items and services that are not medically necessary, seeking payment or reimbursement for services rendered for procedures that are integral to other procedures performed on the same date of service (unbundling), and seeking increased payment or reimbursement for services that would be correctly billed at a lower rate (upcoding). Abuse is healthcare “practices that are inconsistent with accepted sound fiscal, business, or medical practices, and result in an unnecessary cost or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care” (McMacken, 2021). Some examples of healthcare abuse include misusing codes on a claim, charging excessively for services or supplies, and billing for services that were not medically necessary. Both fraud and abuse can expose a provider or vendor to criminal and civil liability, result in higher premiums for the patient, affects the quality of care, result in delay or denial of claims which is a loss to the healthcare organization because the healthcare provider will not be reimbursed for inaccurate or fraudulent claims. This calls for organizations to establish strong and clear processes and procedures to avoid fraudulent reimbursement practices. These processes and procedures should include periodic training and education of staff to keep them updated on new policies and guidelines of reimbursement, establishment of policy and guidelines implementation team to monitor the reimbursement process so as to prevent fraudulent activities and to ensure compliance with set standards, carryout periodic audits both internally and externally for proper evaluation and to verify compliance with guidelines and standards.