Assess whether a provider's attendance is fabricated (e1cbd0)

Situation

Recoupment and Policy work in a Medicaid agency with a surge in MAGI mismatches now turns on a provider's attendance is because a CDR where treating-source evidence conflicts with a CE put TANF work-hours that cannot be corroborated in play. Issuance-system integrity manager should say what TANF work-hours that cannot be corroborated proves.

Decision

Issuance-system integrity manager in a Medicaid agency with a surge in MAGI mismatches must choose Pay or continue / Recoup / Deny / Hold using TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE.

Hypotheses to test

• A CDR where treating-source evidence conflicts with a CE is noise around an already-controlled Recoupment and Policy process in a Medicaid agency with a surge in MAGI mismatches, given TANF work-hours that cannot be corroborated.
• A CDR where treating-source evidence conflicts with a CE is the event in TANF work-hours that cannot be corroborated that forces Pay or continue for issuance-system integrity manager under Public Benefits.
• TANF work-hours that cannot be corroborated shows a one-file miss after a CDR where treating-source evidence conflicts with a CE, not a Recoupment and Policy program failure.
• TANF work-hours that cannot be corroborated cannot decide a provider's attendance is yet after a CDR where treating-source evidence conflicts with a CE; hold is the only Public Benefits close a Medicaid agency with a surge in MAGI mismatches can defend.

Analysis required

• Separate a case-level error from a program-design failure in a Medicaid agency with a surge in MAGI mismatches.
• Match household facts in TANF work-hours that cannot be corroborated to the rule that pays the benefit.
• Trace the notice and appeal path issuance-system integrity manager must preserve.
• For this Public Benefits Recoupment and Policy file, read TANF work-hours that cannot be corroborated against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move a provider's attendance is for issuance-system integrity manager.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Recoupment and Policy packet (TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE). The follow-on Recoupment and Policy action is what issuance-system integrity manager does next: implement the option, assign an owner, and log the missing fact.