Assess whether a provider's attendance is fabricated (cf6180)

Situation

The desk packet is housing overlapping-address and income file after two Section 8 files with the same landlord and overlapping tenants. Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break has to name Pay or continue or Recoup for this Public Benefits Recoupment and Policy file.

Decision

Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break must choose Pay or continue / Recoup / Deny / Hold using housing overlapping-address and income file after two Section 8 files with the same landlord and overlapping tenants.

Hypotheses to test

• The population in housing overlapping-address and income file is the one two Section 8 files with the same landlord and overlapping tenants named, so Pay or continue follows for this Recoupment and Policy file.
• The population in housing overlapping-address and income file is adjacent only to two Section 8 files with the same landlord and overlapping tenants; Recoup is the honest Public Benefits call.
• A benefits issuance vendor after a file-control break already contained two Section 8 files with the same landlord and overlapping tenants before housing overlapping-address and income file arrived; no new Recoupment and Policy path.
• Provenance on housing overlapping-address and income file after two Section 8 files with the same landlord and overlapping tenants is broken; do not pick Pay or continue or Recoup yet.

Analysis required

• Trace the notice and appeal path Medicaid eligibility integrity analyst must preserve.
• Test eligibility, recoupment, and improper-payment facts in housing overlapping-address and income file after two Section 8 files with the same landlord and overlapping tenants.
• Quantify overpayment if a provider's attendance is is wrong.
• For this Public Benefits Recoupment and Policy file, read housing overlapping-address and income file against two Section 8 files with the same landlord and overlapping tenants and write the one fact that would move a provider's attendance is for Medicaid eligibility integrity analyst.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Recoupment and Policy packet (housing overlapping-address and income file after two Section 8 files with the same landlord and overlapping tenants). The follow-on Recoupment and Policy action is what Medicaid eligibility integrity analyst does next: implement the option, assign an owner, and log the missing fact.