Fraud is defined as intentional misrepresentation (commission or omission of relevant acts and/or information) of eligibility or the delivery of services or goods.
Abuse occurs when reimbursement is sought for treatment or goods which are medically unnecessary, excessive or inappropriate. This calls into question the integrity of the practitioner and even the profession, if it occurs on a regular basis. Financial resources are limited and it means others in need go without services. It is transgression of ethical rules and ethical principles. Kickbacks for goods, services or referrals (giving and receiving) are also illegal and are covered in specific guidelines by HPCSA (perverse incentive).

There are more covert forms of fraud, e.g. continuing services until the patient’s funds are exhausted or “diagnosing” a new condition if funds for the existing diagnosis have been exhausted. Particularly in the treatment of children, where continued funding may depend on documented progress, therapist may exaggerate or even manufacture improvement, in the fear that the child has reached a temporary plateau and could benefit from future treatment. However, in turn, this may be to the detriment of other children on the waiting list.

This also raises questions about charging for the treatment for which there is no evidence of benefit, which is complex issue in physiotherapy, linking with selection criteria, which seems to favour potential clinical competency rather than research competency. Both clinicians and academics have valid reasons for the paucity of clinical research to validate practice, but the profession needs to pursue this with vigour in order to provide the evidence on which the integrity of the profession depends.