Assess whether to recoup, waive, or refer for prosecution (81218a)

SITUATION The working file is recoupment aging versus collectability after a USDA retailer disqualification packet due Friday. Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches has to name To recoup, waive, or Refer for prosecution for this Public Benefits Compliance and Integrity Operations file.

DECISION Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches must choose To recoup, waive, / Refer for prosecution using recoupment aging versus collectability after a USDA retailer disqualification packet due Friday.

HYPOTHESES TO TEST 1. Recoupment aging versus collectability reads as To recoup, waive, once a USDA retailer disqualification packet due Friday is lined up to the same Public Benefits population. 2. Recoupment aging versus collectability is closer to Refer for prosecution after a USDA retailer disqualification packet due Friday; To recoup, waive, would over-claim this Compliance and Integrity Operations extract. 3. A dual reading is still live in recoupment aging versus collectability for Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches. 4. Recoupment aging versus collectability is missing the fact Medicaid eligibility integrity analyst needs after a USDA retailer disqualification packet due Friday; stop this Public Benefits close.

ANALYSIS REQUIRED 1. Match household facts in recoupment aging versus collectability to the rule that pays the benefit. 2. Trace the notice and appeal path Medicaid eligibility integrity analyst must preserve. 3. Test eligibility, recoupment, and improper-payment facts in recoupment aging versus collectability after a USDA retailer disqualification packet due Friday. 4. For this Public Benefits Compliance and Integrity Operations file, read recoupment aging versus collectability against a USDA retailer disqualification packet due Friday 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 (recoupment aging versus collectability after a USDA retailer disqualification packet due Friday). 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 recoupment aging versus collectability, then the action for Medicaid eligibility integrity analyst - Hypothesis scorecard against recoupment aging versus collectability: supported / rejected / untestable - Regulatory or exam hook Compliance and Integrity Operations would cite - Compliance and Integrity Operations finding in recoupment aging versus collectability that a second reviewer can re-perform