Assess whether a provider's attendance is fabricated (d51e1c)

Situation

TANF work-hours that cannot be corroborated arrived with a provider billing full-time care during school hours for issuance-system integrity manager. That is a Public Benefits Recoupment and Policy decision on a provider's attendance is in a Medicaid agency with a surge in MAGI mismatches.

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 provider billing full-time care during school hours.

Hypotheses to test

• The population in TANF work-hours that cannot be corroborated is the one a provider billing full-time care during school hours named, so Pay or continue follows for this Recoupment and Policy file.
• The population in TANF work-hours that cannot be corroborated is adjacent only to a provider billing full-time care during school hours; Recoup is the honest Public Benefits call.
• A Medicaid agency with a surge in MAGI mismatches already contained a provider billing full-time care during school hours before TANF work-hours that cannot be corroborated arrived; no new Recoupment and Policy path.
• Provenance on TANF work-hours that cannot be corroborated after a provider billing full-time care during school hours is broken; do not pick Pay or continue or Recoup yet.

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 provider billing full-time care during school hours 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 provider billing full-time care during school hours). If TANF work-hours that cannot be corroborated cannot force a Public Benefits label under Recoupment and Policy, stop. Do not invent pages a Medicaid agency with a surge in MAGI mismatches does not have.