Assess whether to refer to law enforcement or keep civil (c70360)

SITUATION Medicare upcoding CPT pairing table arrived with a check deposited in two banks the same afternoon. Wire-desk escalation officer in a Medicare Advantage claims shop still has an evidence gap on whether to refer to law enforcement or keep civil.

DECISION Wire-desk escalation officer in a Medicare Advantage claims shop must choose To refer to law enforcement / Keep civil using Medicare upcoding CPT pairing table after a check deposited in two banks the same afternoon.

HYPOTHESES TO TEST 1. Authorize To refer to law enforcement now; Medicare upcoding CPT pairing table already has the discriminator after a check deposited in two banks the same afternoon. 2. Keep Keep civil in force until Medicare upcoding CPT pairing table is completed after a check deposited in two banks the same afternoon for wire-desk escalation officer. 3. Treat Medicare upcoding CPT pairing table as To refer to law enforcement because both readings appear after a check deposited in two banks the same afternoon. 4. Refuse a Fraud Detection close: wire-desk escalation officer does not have the decision to refer to law turns on in Medicare upcoding CPT pairing table.

ANALYSIS REQUIRED 1. Check mule or round-trip markers in Medicare upcoding CPT pairing table. 2. Map typology and hold authority wire-desk escalation officer actually has in a Medicare Advantage claims shop. 3. Trace funds, counterparties, and reversals in Medicare upcoding CPT pairing table through the window opened by a check deposited in two banks the same afternoon. 4. For this Fraud Detection Mortgage Fraud file, read Medicare upcoding CPT pairing table against a check deposited in two banks the same afternoon and write the one fact that would move to refer to law for wire-desk escalation officer.

RECOMMENDATION Choose To refer to law enforcement / Keep civil on this Fraud Detection / Mortgage Fraud packet (Medicare upcoding CPT pairing table after a check deposited in two banks the same afternoon). Lead with the Fraud Detection option Medicare upcoding CPT pairing table can support after a check deposited in two banks the same afternoon, then the two facts that force it, then the Monday action for wire-desk escalation officer in a Medicare Advantage claims shop.

COMMAND RETURNS - Bottom-line Fraud Detection option on to refer to law, then the evidence in Medicare upcoding CPT pairing table, then the action for wire-desk escalation officer - Hypothesis scorecard against Medicare upcoding CPT pairing table: supported / rejected / untestable - Regulatory or exam hook Mortgage Fraud would cite - Mortgage Fraud finding in Medicare upcoding CPT pairing table that a second reviewer can re-perform