At a hospital, at the cardiac rehab and orthopedic clinics, there are a number of visits and bills that don't match the numbers of visits billed, thus the CFO cannot reconcile the number of supplies with the supplies currently on hand in the inventory system. He suspects fradulent billing, that the billing department was submitting bills to Medicaid for DME (durable medical equipment) that patients were not prescribed for and that SSN #s were used to bill without the patients being treated that day.
What would you do to approach this situation? What would you do first? Who would you get involved. If you discovered that fraud occurred, what steps should be taken to prevent this from happening again?