I've got a dilemma. A co-worker, who also happens to be a CPC, provided false information to an insurance company. A claim was billed with "physician A" and the claim processed as out-of-network. The patient was required to meet a deductible rather than a copay. This co-worker sent a "corrected" claim to the carrier under "physician B" stating it was incorrect when first filed. This was brought to our attention by the patient when she received a bill. She states she was told by "co-worker" that she would take care of the denial. We have gotten visit notes that are obviously not written by "physician B". Am I overreacting in thinking this is insurance fraud? I'm afraid that if I address it with her she will state she didn't know she couldn't change a physician (yeah, she really will). Does anyone know of any material that I can present to her and our supervisor that will prove that she would have and should have know this was wrong?? Thanks!