Assess whether a provider should be suspended pending SIU (741de7)

Situation

The desk packet is workers'-comp claimant attorney cluster after a mule account receiving 14 unrelated payrolls in a week. SIU investigator in a Medicare Advantage claims shop has to name Remove access or reverse the item or Temporary compensating control for this Fraud Detection Claims and Benefits Fraud file.

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 workers'-comp claimant attorney cluster after a mule account receiving 14 unrelated payrolls in a week.

Hypotheses to test

• Authorize Remove access or reverse the item now; workers'-comp claimant attorney cluster already has the discriminator after a mule account receiving 14 unrelated payrolls in a week.
• Keep Temporary compensating control in force until workers'-comp claimant attorney cluster is completed after a mule account receiving 14 unrelated payrolls in a week for SIU investigator.
• Treat workers'-comp claimant attorney cluster as Approve a documented exception because both readings appear after a mule account receiving 14 unrelated payrolls in a week.
• Refuse a Fraud Detection close: SIU investigator does not have the page a provider should be turns on in workers'-comp claimant attorney cluster.

Analysis required

• Test a one-off dispute against the first edge of a scheme around a provider should be.
• Check mule or round-trip markers in workers'-comp claimant attorney cluster.
• Map typology and hold authority SIU investigator actually has in a Medicare Advantage claims shop.
• For this Fraud Detection Claims and Benefits Fraud file, read workers'-comp claimant attorney cluster against a mule account receiving 14 unrelated payrolls in a week and write the one fact that would move a provider 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 (workers'-comp claimant attorney cluster after a mule account receiving 14 unrelated payrolls in a week). Lead with the Fraud Detection option workers'-comp claimant attorney cluster can support after a mule account receiving 14 unrelated payrolls in a week, then the two facts that force it, then the Monday action for SIU investigator in a Medicare Advantage claims shop.