Which action is appropriate if a physician did not perform the exam and the report is in question?

• A. Object to the report as inadmissible
• B. Contact the physician's office
• C. Report to the Fraud Bureau
• D. Accept the report

Answer: (A)

When a medical report is used in a claim, it must reflect an actual examination by the named physician. If it’s discovered that the physician did not perform the exam, the document’s credibility and admissibility are compromised, because its basis and authenticity are in doubt. The correct action is to object to the report as inadmissible, so it cannot be used as proof of the medical condition. This protects the integrity of the claim file and ensures decisions are based on legitimate evidence. If needed, you would pursue a valid medical evaluation from someone who did perform the exam or request a new, legitimate report. If there’s clear evidence of intentional fraud, reporting it to the Fraud Bureau is appropriate, but the immediate priority in this situation is to challenge the report’s admissibility rather than accept it or take other actions.