Assess whether identity proofing exceptions are being abused (9b2236)

SITUATION The working file is issuance file-control totals that will not balance after a CDR where treating-source evidence conflicts with a CE. Child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches has to name Pay or continue or Recoup for this Public Benefits Trafficking and Eligibility Fraud file.

DECISION Child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches must choose Pay or continue / Recoup / Deny / Hold using issuance file-control totals that will not balance after a CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. The population in issuance file-control totals that will not balance is the one a CDR where treating-source evidence conflicts with a CE named, so Pay or continue follows for this Trafficking and Eligibility Fraud file. 2. The population in issuance file-control totals that will not balance is adjacent only to a CDR where treating-source evidence conflicts with a CE; Recoup is the honest Public Benefits call. 3. A Medicaid agency with a surge in MAGI mismatches already contained a CDR where treating-source evidence conflicts with a CE before issuance file-control totals that will not balance arrived; no new Trafficking and Eligibility Fraud path. 4. Provenance on issuance file-control totals that will not balance after a CDR where treating-source evidence conflicts with a CE is broken; do not pick Pay or continue or Recoup yet.

ANALYSIS REQUIRED 1. Trace the notice and appeal path child-care provider integrity lead must preserve. 2. Test eligibility, recoupment, and improper-payment facts in issuance file-control totals that will not balance after a CDR where treating-source evidence conflicts with a CE. 3. Quantify overpayment if identity proofing exceptions are is wrong. 4. For this Public Benefits Trafficking and Eligibility Fraud file, read issuance file-control totals that will not balance against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move identity proofing exceptions are for child-care provider integrity lead.

RECOMMENDATION The actionable close on issuance file-control totals that will not balance is Pay or continue if a CDR where treating-source evidence conflicts with a CE left a complete Trafficking and Eligibility Fraud trail; otherwise Recoup. Child-care provider integrity lead should cite the specific line in issuance file-control totals that will not balance that settles identity proofing exceptions are before anyone else acts in a Medicaid agency with a surge in MAGI mismatches.

COMMAND RETURNS - Bottom-line Public Benefits option on identity proofing exceptions are, then the evidence in issuance file-control totals that will not balance, then the action for child-care provider integrity lead - Hypothesis scorecard against issuance file-control totals that will not balance: supported / rejected / untestable - Named option among Pay or continue, Recoup, Deny and the fact that kills the others - Owner and next date for child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches