What should be done upon identifying a recurring pattern of unusual claims from a provider?

Upon identifying a recurring pattern of unusual claims from a provider, the appropriate action is to report to the compliance department. This step is crucial because unusual claims may be indicative of potential fraud, waste, or abuse. By bringing these patterns to the attention of the compliance department, you enable the organization to investigate further and, if necessary, take corrective actions to safeguard the integrity of the healthcare system.

The compliance department is equipped to handle such reports, conducting thorough investigations and implementing necessary measures to address any issues found. Reporting ensures that the organization remains compliant with regulations and protects patients and the healthcare system from potential harm linked to fraudulent activities. This proactive approach can help mitigate risks and promote ethical practices within the healthcare industry.