Assess whether linked accounts should be treated as one case (13cebe)

Situation

In a Medicare Advantage claims shop, synthetic identity application cluster is the evidence after three applications sharing one employer EIN and no payroll. SIU investigator has to pick Remove access or reverse the item or Temporary compensating control for this Fraud Detection Claims and Benefits Fraud close using synthetic identity application cluster.

Decision

SIU investigator in a Medicare Advantage claims shop must choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold using synthetic identity application cluster after three applications sharing one employer EIN and no payroll.

Hypotheses to test

• SIU investigator can defend Remove access or reverse the item from synthetic identity application cluster after three applications sharing one employer EIN and no payroll in a Fraud Detection challenge.
• SIU investigator cannot defend Remove access or reverse the item from synthetic identity application cluster; Temporary compensating control is what the extract actually supports after three applications sharing one employer EIN and no payroll.
• Three applications sharing one employer EIN and no payroll never reached the population in synthetic identity application cluster — reopen intake, do not close linked accounts should be.
• Two facts in synthetic identity application cluster after three applications sharing one employer EIN and no payroll conflict for SIU investigator; hold this Claims and Benefits Fraud file.

Analysis required

• Quantify loss if the hold is released before synthetic identity application cluster is complete.
• Test a one-off dispute against the first edge of a scheme around linked accounts should be.
• Check mule or round-trip markers in synthetic identity application cluster.
• For this Fraud Detection Claims and Benefits Fraud file, read synthetic identity application cluster against three applications sharing one employer EIN and no payroll and write the one fact that would move linked accounts should be for SIU investigator.

Recommendation

Choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold on this Fraud Detection / Claims and Benefits Fraud packet (synthetic identity application cluster after three applications sharing one employer EIN and no payroll). The follow-on Claims and Benefits Fraud action is what SIU investigator does next: implement the option, assign an owner, and log the missing fact.