Discussion 2.1: Essentials


Imagine that 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-provided services.

  • What would you do?
  • How would you justify this action based on legal and ethical guidelines?