Assess whether a provider's attendance is fabricated (232cb9)

Situation

Child-care provider integrity lead in a benefits issuance vendor after a file-control break has one working extract — disability CDR medical-evidence pack — after a provider billing full-time care during school hours. If disability CDR medical-evidence pack cannot support a provider's attendance is, the honest Public Benefits output is hold.

Decision

Child-care provider integrity lead in a benefits issuance vendor after a file-control break must choose Pay or continue / Recoup / Deny / Hold using disability CDR medical-evidence pack after a provider billing full-time care during school hours.

Hypotheses to test

• Disability CDR medical-evidence pack reads as Pay or continue once a provider billing full-time care during school hours is lined up to the same Public Benefits population.
• Disability CDR medical-evidence pack is closer to Recoup after a provider billing full-time care during school hours; Pay or continue would over-claim this Compliance and Integrity Operations extract.
• Deny is still live in disability CDR medical-evidence pack for child-care provider integrity lead in a benefits issuance vendor after a file-control break.
• Disability CDR medical-evidence pack is missing the fact child-care provider integrity lead needs after a provider billing full-time care during school hours; stop this Public Benefits close.

Analysis required

• Test eligibility, recoupment, and improper-payment facts in disability CDR medical-evidence pack after a provider billing full-time care during school hours.
• Quantify overpayment if a provider's attendance is is wrong.
• Separate a case-level error from a program-design failure in a benefits issuance vendor after a file-control break.
• For this Public Benefits Compliance and Integrity Operations file, read disability CDR medical-evidence pack against a provider billing full-time care during school hours and write the one fact that would move a provider's attendance is for child-care provider integrity lead.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Compliance and Integrity Operations packet (disability CDR medical-evidence pack after a provider billing full-time care during school hours). The follow-on Compliance and Integrity Operations action is what child-care provider integrity lead does next: implement the option, assign an owner, and log the missing fact.