Assess whether a retailer should be disqualified (176b43)

Situation

Retailer trafficking red-flag report arrived with a thousand UI claims from one IP block for disability continuing-eligibility reviewer. That is a Public Benefits Compliance and Integrity Operations decision on a retailer should be disqualified in a disability unit facing a backlog of CDRs.

Decision

Disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs must choose Pay or continue / Recoup / Deny / Hold using retailer trafficking red-flag report after a thousand UI claims from one IP block.

Hypotheses to test

• The population in retailer trafficking red-flag report is the one a thousand UI claims from one IP block named, so Pay or continue follows for this Compliance and Integrity Operations file.
• The population in retailer trafficking red-flag report is adjacent only to a thousand UI claims from one IP block; Recoup is the honest Public Benefits call.
• A disability unit facing a backlog of CDRs already contained a thousand UI claims from one IP block before retailer trafficking red-flag report arrived; no new Compliance and Integrity Operations path.
• Provenance on retailer trafficking red-flag report after a thousand UI claims from one IP block is broken; do not pick Pay or continue or Recoup yet.

Analysis required

• Match household facts in retailer trafficking red-flag report to the rule that pays the benefit.
• Trace the notice and appeal path disability continuing-eligibility reviewer must preserve.
• Test eligibility, recoupment, and improper-payment facts in retailer trafficking red-flag report after a thousand UI claims from one IP block.
• For this Public Benefits Compliance and Integrity Operations file, read retailer trafficking red-flag report against a thousand UI claims from one IP block and write the one fact that would move a retailer should be disqualified for disability continuing-eligibility reviewer.

Recommendation

Choose Pay or continue / Recoup / Deny / Hold on this Public Benefits / Compliance and Integrity Operations packet (retailer trafficking red-flag report after a thousand UI claims from one IP block). Lead with the Public Benefits option retailer trafficking red-flag report can support after a thousand UI claims from one IP block, then the two facts that force it, then the Monday action for disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs.