What constitutes fraud according to CMS?

Fraud, as defined by the Centers for Medicare & Medicaid Services (CMS), predominantly revolves around the act of making false statements or misrepresentations to gain benefits that one is not entitled to. This involves an intentional deception or misconduct that can include falsifying information to secure payment for services that were not provided, misrepresenting the codes used for billing, or inflating the costs of procedures or services. The heart of fraud lies in the deliberate attempt to deceive, which is what Option A highlights clearly.

In contrast, the other options describe situations that may be unethical or wrong but do not necessarily meet the definition of fraud as specified by CMS. For instance, providing unnecessary services (Option B) might involve over-utilization or malpractice, but it does not imply the intent to deceive. Billing at a lower level than necessary (Option C) could be seen as an error or an attempt to be honest rather than an act of fraud, as it does not involve making a false representation with the intent to deceive. Lastly, cooperating with investigations (Option D) is not related to fraud itself; instead, it is a legal and ethical obligation during the auditing process, which would not contribute to constituting fraudulent behavior.

Thus, the correct answer is based