Assess whether to recoup, waive, or refer for prosecution from EBT

SITUATION Medicaid eligibility integrity analyst is responsible for to recoup, waive, or refer in a child-care subsidy program, using related-provider clusters with EBT out-of-state redemption cluster as the only working extract. A CDR where treating-source evidence conflicts with a CE is what reset the timeline for this Public Benefits Trafficking and Eligibility Fraud file.

DECISION Medicaid eligibility integrity analyst in a child-care subsidy program with related-provider clusters must choose To recoup, waive, / Refer for prosecution using EBT out-of-state redemption cluster after a CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. Medicaid eligibility integrity analyst can defend To recoup, waive, from EBT out-of-state redemption cluster after a CDR where treating-source evidence conflicts with a CE in a Public Benefits challenge. 2. Medicaid eligibility integrity analyst cannot defend To recoup, waive, from EBT out-of-state redemption cluster; Refer for prosecution is what the extract actually supports after a CDR where treating-source evidence conflicts with a CE. 3. A CDR where treating-source evidence conflicts with a CE never reached the population in EBT out-of-state redemption cluster — reopen intake, do not close to recoup, waive, or refer. 4. Two facts in EBT out-of-state redemption cluster after a CDR where treating-source evidence conflicts with a CE conflict for Medicaid eligibility integrity analyst; hold this Trafficking and Eligibility Fraud file.

ANALYSIS REQUIRED 1. Quantify overpayment if to recoup, waive, or refer is wrong. 2. Separate a case-level error from a program-design failure in a child-care subsidy program with related-provider clusters. 3. Match household facts in EBT out-of-state redemption cluster to the rule that pays the benefit. 4. For this Public Benefits Trafficking and Eligibility Fraud file, read EBT out-of-state redemption cluster against a CDR where treating-source evidence conflicts with a CE and write the one fact that would move to recoup, waive, or refer for Medicaid eligibility integrity analyst.

RECOMMENDATION Choose To recoup, waive, / Refer for prosecution on this Public Benefits / Trafficking and Eligibility Fraud packet (EBT out-of-state redemption cluster after a CDR where treating-source evidence conflicts with a CE). The follow-on Trafficking and Eligibility Fraud action is what Medicaid eligibility integrity analyst does next: implement the option, assign an owner, and log the missing fact.

COMMAND RETURNS - Bottom-line Public Benefits option on to recoup, waive, or refer, then the evidence in EBT out-of-state redemption cluster, then the action for Medicaid eligibility integrity analyst - Hypothesis scorecard against EBT out-of-state redemption cluster: supported / rejected / untestable - Owner and next date for Medicaid eligibility integrity analyst in a child-care subsidy program with related-provider clusters - What changes to recoup, waive, or refer if a CDR where treating-source evidence conflicts with a CE is later withdrawn