Assess whether a claims ring exists or is coincidental overlap (fdabd6)

Situation

Medicare upcoding CPT pairing table arrived with a customer calling to reverse a 'authorized' card charge for SIU investigator. That is a Fraud Detection Credit and Identity Fraud decision on a claims ring exists in a regional bank's card portfolio.

Decision

SIU investigator in a regional bank's card portfolio must choose A claims ring exists / Is coincidental overlap using Medicare upcoding CPT pairing table after a customer calling to reverse a 'authorized' card charge.

Hypotheses to test

• The population in Medicare upcoding CPT pairing table is the one a customer calling to reverse a 'authorized' card charge named, so A claims ring exists follows for this Credit and Identity Fraud file.
• The population in Medicare upcoding CPT pairing table is adjacent only to a customer calling to reverse a 'authorized' card charge; Is coincidental overlap is the honest Fraud Detection call.
• A regional bank's card portfolio already contained a customer calling to reverse a 'authorized' card charge before Medicare upcoding CPT pairing table arrived; no new Credit and Identity Fraud path.
• Provenance on Medicare upcoding CPT pairing table after a customer calling to reverse a 'authorized' card charge is broken; do not pick A claims ring exists or Is coincidental overlap yet.

Analysis required

• Trace funds, counterparties, and reversals in Medicare upcoding CPT pairing table through the window opened by a customer calling to reverse a 'authorized' card charge.
• Quantify loss if the hold is released before Medicare upcoding CPT pairing table is complete.
• Test a one-off dispute against the first edge of a scheme around a claims ring exists.
• For this Fraud Detection Credit and Identity Fraud file, read Medicare upcoding CPT pairing table against a customer calling to reverse a 'authorized' card charge and write the one fact that would move a claims ring exists for SIU investigator.

Recommendation

Choose A claims ring exists / Is coincidental overlap on this Fraud Detection / Credit and Identity Fraud packet (Medicare upcoding CPT pairing table after a customer calling to reverse a 'authorized' card charge). The follow-on Credit and Identity Fraud action is what SIU investigator does next: implement the option, assign an owner, and log the missing fact.