Assess whether a retailer should be disqualified (85f249)

Situation

Issuance file-control totals that will not balance arrived with a hearing officer reversing 40% of trafficking cases for issuance-system integrity manager. That is a Public Benefits Recoupment and Policy decision on a retailer should be disqualified 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 issuance file-control totals that will not balance after a hearing officer reversing 40% of trafficking cases.

Hypotheses to test

• Issuance file-control totals that will not balance reads as Pay or continue once a hearing officer reversing 40% of trafficking cases is lined up to the same Public Benefits population.
• Issuance file-control totals that will not balance is closer to Recoup after a hearing officer reversing 40% of trafficking cases; Pay or continue would over-claim this Recoupment and Policy extract.
• Deny is still live in issuance file-control totals that will not balance for issuance-system integrity manager in a Medicaid agency with a surge in MAGI mismatches.
• Issuance file-control totals that will not balance is missing the fact issuance-system integrity manager needs after a hearing officer reversing 40% of trafficking cases; stop this Public Benefits close.

Analysis required

• Quantify overpayment if a retailer should be disqualified is wrong.
• Separate a case-level error from a program-design failure in a Medicaid agency with a surge in MAGI mismatches.
• Match household facts in issuance file-control totals that will not balance to the rule that pays the benefit.
• For this Public Benefits Recoupment and Policy file, read issuance file-control totals that will not balance against a hearing officer reversing 40% of trafficking cases and write the one fact that would move a retailer should be disqualified for issuance-system integrity manager.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Recoupment and Policy packet (issuance file-control totals that will not balance after a hearing officer reversing 40% of trafficking cases). Lead with the Public Benefits option issuance file-control totals that will not balance can support after a hearing officer reversing 40% of trafficking cases, then the two facts that force it, then the Monday action for issuance-system integrity manager in a Medicaid agency with a surge in MAGI mismatches.