RHIT Practice Exam 2025 – Complete Study Resource

Misrepresentation of patient information through incorrect coding falls under healthcare fraud because it involves intentional deception to gain an unauthorized benefit, typically financial. In the context of medical coding, when a coding professional purposefully miscodes or misrepresents information, it can lead to erroneous claims being submitted to insurers, resulting in payments that should not have been authorized. This act demonstrates willful misconduct with the intent to defraud or deceive, which is at the core of healthcare fraud.

While data entry errors, billing oversights, and compliance breaches can involve incorrect coding, they generally pertain to unintentional mistakes or failures to follow established guidelines and regulations. In contrast, healthcare fraud implies an active intent to mislead for personal or organizational gain, which is clearly reflected in the scenario provided.