Assess whether to recoup, waive, or refer for prosecution (c5a4a1)

SITUATION Two Section 8 files with the same landlord and overlapping tenants put retailer trafficking red-flag report in front of Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches. This Public Benefits / Compliance and Integrity Operations close is to recoup, waive, or refer from retailer trafficking red-flag report, and the live options are To recoup, waive,, Refer for prosecution.

DECISION Medicaid eligibility integrity analyst in a Medicaid agency with a surge in MAGI mismatches must choose To recoup, waive, / Refer for prosecution using retailer trafficking red-flag report after two Section 8 files with the same landlord and overlapping tenants.

HYPOTHESES TO TEST 1. The population in retailer trafficking red-flag report is the one two Section 8 files with the same landlord and overlapping tenants named, so To recoup, waive, follows for this Compliance and Integrity Operations file. 2. The population in retailer trafficking red-flag report is adjacent only to two Section 8 files with the same landlord and overlapping tenants; Refer for prosecution is the honest Public Benefits call. 3. A Medicaid agency with a surge in MAGI mismatches already contained two Section 8 files with the same landlord and overlapping tenants before retailer trafficking red-flag report arrived; no new Compliance and Integrity Operations path. 4. Provenance on retailer trafficking red-flag report after two Section 8 files with the same landlord and overlapping tenants 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 retailer trafficking red-flag report 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 retailer trafficking red-flag report against two Section 8 files with the same landlord and overlapping tenants 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 (retailer trafficking red-flag report after two Section 8 files with the same landlord and overlapping tenants). If retailer trafficking red-flag report cannot force a Public Benefits label under Compliance and Integrity Operations, stop. If retailer trafficking red-flag report after two Section 8 files with the same landlord and overlapping tenants cannot support To recoup, waive, versus Refer for prosecution on this Public Benefits Compliance and Integrity Operations close, Medicaid eligibility integrity analyst must do not pay, recoup, or deny beyond the eligibility record.