Assess whether to refer to law enforcement or keep civil (afb022)

SITUATION Mortgage Fraud work in a Medicare Advantage claims shop now turns on to refer to law because a mortgage occupancy affidavit contradicting utility records put Medicare upcoding CPT pairing table in play. Mortgage Fraud work in a Medicare Advantage claims shop now turns on to refer to law because a mortgage occupancy affidavit contradicting utility records put Medicare upcoding CPT pairing table in play; wire-desk escalation officer should say what Medicare upcoding CPT pairing table proves for Fraud Detection.

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 mortgage occupancy affidavit contradicting utility records.

HYPOTHESES TO TEST 1. Medicare upcoding CPT pairing table reads as To refer to law enforcement once a mortgage occupancy affidavit contradicting utility records is lined up to the same Fraud Detection population. 2. Medicare upcoding CPT pairing table is closer to Keep civil after a mortgage occupancy affidavit contradicting utility records; To refer to law enforcement would over-claim this Mortgage Fraud extract. 3. A dual reading is still live in Medicare upcoding CPT pairing table for wire-desk escalation officer in a Medicare Advantage claims shop. 4. Medicare upcoding CPT pairing table is missing the fact wire-desk escalation officer needs after a mortgage occupancy affidavit contradicting utility records; stop this Fraud Detection close.

ANALYSIS REQUIRED 1. Test a one-off dispute against the first edge of a scheme around to refer to law. 2. Check mule or round-trip markers in Medicare upcoding CPT pairing table. 3. Map typology and hold authority wire-desk escalation officer actually has in a Medicare Advantage claims shop. 4. For this Fraud Detection Mortgage Fraud file, read Medicare upcoding CPT pairing table against a mortgage occupancy affidavit contradicting utility records 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 mortgage occupancy affidavit contradicting utility records). The follow-on Mortgage Fraud action is what wire-desk escalation officer does next: implement the option, assign an owner, and log the missing fact.

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 - Mortgage Fraud finding in Medicare upcoding CPT pairing table that a second reviewer can re-perform - Missing page in Medicare upcoding CPT pairing table after a mortgage occupancy affidavit contradicting utility records, if any