What action may be taken if there is reliable evidence of fraud?

• A. Deny or suspend payments to providers
• B. Increase payment rates
• C. Expand coverage without review
• D. Remove all provider records from system

Answer: (A)

When there is reliable evidence of fraud, the immediate course is to deny or suspend payments to the involved providers. Stopping payments prevents ongoing loss and preserves funds while an investigation can proceed, maintaining accountability and supporting recovery of any overpayments. It also helps protect other program activities from being affected by the fraudulent claims.

Increasing payment rates would worsen the problem by funding the fraud. Expanding coverage without review bypasses controls and could pay for improper services. Removing all provider records is an extreme action that would disrupt legitimate operations and isn’t a targeted response to fraud.