When discussing fraud and abuse, it often (very often) becomes a philosophical discussion of whether aberrant activities are fraudulent or abusive. The quick difference being that fraudulent is intentional and abuse is not. The distinction quickly becomes an issue of legal and illegal as opposed to right and wrong.
What appears to be true in standard insurance (P&C and life) and banking is that any inappropriate or aberrant activity is assumed to be intentional and there is little shelter for the perpetrator from investigation. However, that is where health care strays from the course because of the status and authority wielded by doctors (and various medical associations, such as the AMA). The waters quickly become very murky. Now that is not to say there is not some justification and appropriateness to this situation, for indeed to tell a doctor that their behavior or practices are wrong is a very slippery slope. For who defines the measure for "quality of care?" Is it the doctor who has direct contact with the patient, and therefore has the best perspective on the patient’s needs? Of course that then assumes that all doctors are of the highest moral character and that they would never do anything opportunistic (clearly a fallacy).
The health care community (in general, not a 100%) has come to accept that from a legal perspective, slight deviations are counted as accidental, whether they are or not.
A simple example: If a doctor seess a patient for 15 minutes and bills for 30 minutes (up-coding) that is usually considered abusive. However, in the banking or insurance industry, it would certainly not be. Many people find the acceptance of this unacceptable or inappropriate, yet doctors maintain a position of respect (that is well earned) and should every medical procedure be open to question? Cleary there is no simple answer to the question at hand, and the common resolution today is to warn the doctors and hope they stop, or wait for something extremely inappropriate to occur. (Clearly a great deal of money may be spent waiting.) But should doctors be limited in the services they provide based on their professional opinions, or should they be given carte blanche to do and bill as they please? And what do we call it when they stray outside the lines: fraud or abuse?