Assess whether to recoup, waive, or refer for prosecution (90464f)

SITUATION Compliance and Integrity Operations work in a Medicaid agency with a surge in MAGI mismatches now turns on to recoup, waive, or refer because a thousand UI claims from one IP block put housing overlapping-address and income file in play. Medicaid eligibility integrity analyst should say what housing overlapping-address and income file proves.

DECISION Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches must choose To recoup, waive, / Refer for prosecution using housing overlapping-address and income file after a thousand UI claims from one IP block.

HYPOTHESES TO TEST 1. The population in housing overlapping-address and income file is the one a thousand UI claims from one IP block named, so To recoup, waive, follows for this Compliance and Integrity Operations file. 2. The population in housing overlapping-address and income file is adjacent only to a thousand UI claims from one IP block; Refer for prosecution is the honest Public Benefits call. 3. A Medicaid agency with a surge in MAGI mismatches already contained a thousand UI claims from one IP block before housing overlapping-address and income file arrived; no new Compliance and Integrity Operations path. 4. Provenance on housing overlapping-address and income file after a thousand UI claims from one IP block is broken; do not pick To recoup, waive, or Refer for prosecution yet.

ANALYSIS REQUIRED 1. Separate a case-level error from a program-design failure in a Medicaid agency with a surge in MAGI mismatches. 2. Match household facts in housing overlapping-address and income file to the rule that pays the benefit. 3. Trace the notice and appeal path Medicaid eligibility integrity analyst must preserve. 4. For this Public Benefits Compliance and Integrity Operations file, read housing overlapping-address and income file against a thousand UI claims from one IP block 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 / Compliance and Integrity Operations packet (housing overlapping-address and income file after a thousand UI claims from one IP block). The follow-on Compliance and Integrity Operations 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 housing overlapping-address and income file, then the action for Medicaid eligibility integrity analyst - Hypothesis scorecard against housing overlapping-address and income file: supported / rejected / untestable - What changes to recoup, waive, or refer if a thousand UI claims from one IP block is later withdrawn - Named option among To recoup, waive,, Refer for prosecution and the fact that kills the others