Assess whether to refer to law enforcement or keep civil from straw-buyer

SITUATION After a customer calling to reverse a 'authorized' card charge, straw-buyer occupancy file is what claims special-investigation lead can touch in a Medicare Advantage claims shop. Fraud Detection will live with To refer to law enforcement versus Keep civil on this Credit and Identity Fraud file.

DECISION Claims special-investigation lead in a Medicare Advantage claims shop must choose To refer to law enforcement / Keep civil using straw-buyer occupancy file after a customer calling to reverse a 'authorized' card charge.

HYPOTHESES TO TEST 1. The population in straw-buyer occupancy file is the one a customer calling to reverse a 'authorized' card charge named, so To refer to law enforcement follows for this Credit and Identity Fraud file. 2. The population in straw-buyer occupancy file is adjacent only to a customer calling to reverse a 'authorized' card charge; Keep civil is the honest Fraud Detection call. 3. A Medicare Advantage claims shop already contained a customer calling to reverse a 'authorized' card charge before straw-buyer occupancy file arrived; no new Credit and Identity Fraud path. 4. Provenance on straw-buyer occupancy file after a customer calling to reverse a 'authorized' card charge is broken; do not pick To refer to law enforcement or Keep civil yet.

ANALYSIS REQUIRED 1. Trace funds, counterparties, and reversals in straw-buyer occupancy file through the window opened by a customer calling to reverse a 'authorized' card charge. 2. Quantify loss if the hold is released before straw-buyer occupancy file is complete. 3. Test a one-off dispute against the first edge of a scheme around to refer to law. 4. For this Fraud Detection Credit and Identity Fraud file, read straw-buyer occupancy file against a customer calling to reverse a 'authorized' card charge and write the one fact that would move to refer to law for claims special-investigation lead.

RECOMMENDATION Choose To refer to law enforcement / Keep civil on this Fraud Detection / Credit and Identity Fraud packet (straw-buyer occupancy file after a customer calling to reverse a 'authorized' card charge). Lead with the Fraud Detection option straw-buyer occupancy file can support after a customer calling to reverse a 'authorized' card charge, then the two facts that force it, then the Monday action for claims special-investigation lead in a Medicare Advantage claims shop.

COMMAND RETURNS - Bottom-line Fraud Detection option on to refer to law, then the evidence in straw-buyer occupancy file, then the action for claims special-investigation lead - Hypothesis scorecard against straw-buyer occupancy file: supported / rejected / untestable - Regulatory or exam hook Credit and Identity Fraud would cite - Credit and Identity Fraud finding in straw-buyer occupancy file that a second reviewer can re-perform