What must a billing company do immediately after determining there is credible evidence of fraud?

When a billing company discovers credible evidence of fraud, it has a legal and ethical obligation to report the misconduct to the appropriate authorities. This action is crucial for several reasons. First, it helps to uphold the integrity of the healthcare system and ensures that fraudulent activities are investigated and addressed. Reporting to authorities can prevent further fraudulent activities and protect patients and the healthcare organization from potential harm.

Additionally, timely reporting demonstrates the billing company’s commitment to compliance and ethical standards, which is essential in maintaining trust with patients, regulators, and other stakeholders in the healthcare system. Notifying the public or ceasing operations may not be required at this stage and could lead to misinformation or disruptions in patient care. Calling for an independent review is a good practice but typically follows the initial reporting to authorities, rather than being the immediate action taken when fraud is suspected. Thus, the obligation to report to the appropriate authorities is the most critical and immediate step that needs to be taken.