Assess whether to recoup, waive, or refer for prosecution after a MAGI

SITUATION The working file is retailer trafficking red-flag report after a MAGI mismatch that could be a household-size coding error. Issuance-system integrity manager in a disability unit facing a backlog of CDRs has to name To recoup, waive, or Refer for prosecution for this Public Benefits Trafficking and Eligibility Fraud file.

DECISION Issuance-system integrity manager in a disability unit facing a backlog of CDRs must choose To recoup, waive, / Refer for prosecution using retailer trafficking red-flag report after a MAGI mismatch that could be a household-size coding error.

HYPOTHESES TO TEST 1. Retailer trafficking red-flag report reads as To recoup, waive, once a MAGI mismatch that could be a household-size coding error is lined up to the same Public Benefits population. 2. Retailer trafficking red-flag report is closer to Refer for prosecution after a MAGI mismatch that could be a household-size coding error; To recoup, waive, would over-claim this Trafficking and Eligibility Fraud extract. 3. A dual reading is still live in retailer trafficking red-flag report for issuance-system integrity manager in a disability unit facing a backlog of CDRs. 4. Retailer trafficking red-flag report is missing the fact issuance-system integrity manager needs after a MAGI mismatch that could be a household-size coding error; stop this Public Benefits close.

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 disability unit facing a backlog of CDRs. 3. Match household facts in retailer trafficking red-flag report to the rule that pays the benefit. 4. For this Public Benefits Trafficking and Eligibility Fraud file, read retailer trafficking red-flag report against a MAGI mismatch that could be a household-size coding error and write the one fact that would move to recoup, waive, or refer for issuance-system integrity manager.

RECOMMENDATION Choose To recoup, waive, / Refer for prosecution on this Public Benefits / Trafficking and Eligibility Fraud packet (retailer trafficking red-flag report after a MAGI mismatch that could be a household-size coding error). The follow-on Trafficking and Eligibility Fraud action is what issuance-system integrity manager 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 retailer trafficking red-flag report, then the action for issuance-system integrity manager - Hypothesis scorecard against retailer trafficking red-flag report: supported / rejected / untestable - Owner and next date for issuance-system integrity manager in a disability unit facing a backlog of CDRs - What changes to recoup, waive, or refer if a MAGI mismatch that could be a household-size coding error is later withdrawn