Assess whether to recoup, waive, or refer for prosecution (941528)

SITUATION After a CDR where treating-source evidence conflicts with a CE, TANF work-hours that cannot be corroborated is what Medicaid eligibility integrity analyst can touch in a benefits issuance vendor after a file-control break. Public Benefits will live with To recoup, waive, versus Refer for prosecution on this Recoupment and Policy file.

DECISION Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break must choose To recoup, waive, / Refer for prosecution using TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE.

HYPOTHESES TO TEST 1. TANF work-hours that cannot be corroborated reads as To recoup, waive, once a CDR where treating-source evidence conflicts with a CE is lined up to the same Public Benefits population. 2. TANF work-hours that cannot be corroborated is closer to Refer for prosecution after a CDR where treating-source evidence conflicts with a CE; To recoup, waive, would over-claim this Recoupment and Policy extract. 3. A dual reading is still live in TANF work-hours that cannot be corroborated for Medicaid eligibility integrity analyst in a benefits issuance vendor after a file-control break. 4. TANF work-hours that cannot be corroborated is missing the fact Medicaid eligibility integrity analyst needs after a CDR where treating-source evidence conflicts with a CE; stop this Public Benefits close.

ANALYSIS REQUIRED 1. Separate a case-level error from a program-design failure in a benefits issuance vendor after a file-control break. 2. Match household facts in TANF work-hours that cannot be corroborated 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 Recoupment and Policy file, read TANF work-hours that cannot be corroborated 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 / Recoupment and Policy packet (TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE). If TANF work-hours that cannot be corroborated cannot force a Public Benefits label under Recoupment and Policy, stop. If TANF work-hours that cannot be corroborated after a CDR where treating-source evidence conflicts with a CE cannot support To recoup, waive, versus Refer for prosecution on this Public Benefits Recoupment and Policy close, Medicaid eligibility integrity analyst must do not pay, recoup, or deny beyond the eligibility record.