Assess whether a trial site should be referred (73c4f4)

Situation

Model-risk exam request list arrived with a provider with a sudden modifier-25 spike for HHS-OIG health-fraud analyst. That is a US Federal Public Sector Audit Investigations decision on a trial site should be referred in an exporter with a possible OFAC touchpoint.

Decision

HHS-OIG health-fraud analyst in an exporter with a possible OFAC touchpoint must choose Pursue / Pursue with conditions / Partner / No-bid using model-risk exam request list after a provider with a sudden modifier-25 spike.

Hypotheses to test

• HHS-OIG health-fraud analyst can defend Pursue from model-risk exam request list after a provider with a sudden modifier-25 spike in a US Federal challenge.
• HHS-OIG health-fraud analyst cannot defend Pursue from model-risk exam request list; Pursue with conditions is what the extract actually supports after a provider with a sudden modifier-25 spike.
• A provider with a sudden modifier-25 spike never reached the population in model-risk exam request list — reopen intake, do not close a trial site should be referred.
• Two facts in model-risk exam request list after a provider with a sudden modifier-25 spike conflict for HHS-OIG health-fraud analyst; hold this Public Sector Audit Investigations file.

Analysis required

• Normalize pricing and CPARS/QASP evidence that actually supports a trial site should be referred.
• Compare PTW and compliance gates in model-risk exam request list to a pursue / partner / no-bid split.
• Test OCI and SAM.gov status before an exporter with a possible OFAC touchpoint commits.
• For this US Federal Public Sector Audit Investigations file, read model-risk exam request list against a provider with a sudden modifier-25 spike and write the one fact that would move a trial site should be referred for HHS-OIG health-fraud analyst.

Recommendation

Choose Pursue / Pursue with conditions / Partner / No-bid on this US Federal / Public Sector Audit Investigations packet (model-risk exam request list after a provider with a sudden modifier-25 spike). Lead with the US Federal option model-risk exam request list can support after a provider with a sudden modifier-25 spike, then the two facts that force it, then the Monday action for HHS-OIG health-fraud analyst in an exporter with a possible OFAC touchpoint.