You are an NP who sees mostly post-head trauma patients and refers many of these patients to physical and occupational services. On one routine follow-up visit, your patient claims that he has not had any of the services you suggested, even though you saw several bills from the consulting provider.

You ask for an audit and discover that the owner of the service submitted $1.28 million in claims for occupational therapy services that were not provided. The owner used Medicaid provider numbers of licensed therapists without their consent to bill for the never-performed services.

a. What is your first action?

b. How do you justify this action based on legal and ethical guidelines?

c. What is your second action?

d. How do you justify this action based on legal and ethical guidelines?

e. What is your final action?

f. How do you justify this action based on legal and ethical guidelines?

AppendixLO1