Which term means intentional or deliberate misrepresentation for financial gain?

• A. Defamation
• B. Risk Management
• C. Scope of Practice
• D. Insurance Fraud

Answer: (D)

Intentional misrepresentation for financial gain is insurance fraud. In dental practice, this means knowingly submitting false or misleading insurance claims to obtain payment, such as billing for services not performed, upcoding to secure higher reimbursement, or misrepresenting the necessity of treatment. It’s a legal violation because it involves deliberate deception for money within the insurance system and can lead to criminal charges, fines, restitution, and possible license action. The other terms describe different ideas: defamation concerns false statements that harm someone’s reputation, risk management is about preventing losses and managing uncertainties, and scope of practice defines what procedures a licensed clinician may perform.