Assess whether an eligibility case is error, fraud, or both (4de345)

Situation

Child-care provider integrity lead in a disability unit facing a backlog of CDRs has one working extract — issuance file-control totals that will not balance — after a provider billing full-time care during school hours. If issuance file-control totals that will not balance cannot support an eligibility case is, the honest Public Benefits output is hold.

Decision

Child-care provider integrity lead in a disability unit facing a backlog of CDRs must choose An eligibility case is error, fraud, / Both using issuance file-control totals that will not balance after a provider billing full-time care during school hours.

Hypotheses to test

• Issuance file-control totals that will not balance reads as An eligibility case is error, fraud, once a provider billing full-time care during school hours is lined up to the same Public Benefits population.
• Issuance file-control totals that will not balance is closer to Both after a provider billing full-time care during school hours; An eligibility case is error, fraud, would over-claim this Recoupment and Policy extract.
• A dual reading is still live in issuance file-control totals that will not balance for child-care provider integrity lead in a disability unit facing a backlog of CDRs.
• Issuance file-control totals that will not balance is missing the fact child-care provider integrity lead needs after a provider billing full-time care during school hours; stop this Public Benefits close.

Analysis required

• Test eligibility, recoupment, and improper-payment facts in issuance file-control totals that will not balance after a provider billing full-time care during school hours.
• Quantify overpayment if an eligibility case is is wrong.
• Separate a case-level error from a program-design failure in a disability unit facing a backlog of CDRs.
• For this Public Benefits Recoupment and Policy file, read issuance file-control totals that will not balance against a provider billing full-time care during school hours and write the one fact that would move an eligibility case is for child-care provider integrity lead.

Recommendation

Choose An eligibility case is error, fraud, / Both on this Public Benefits / Recoupment and Policy packet (issuance file-control totals that will not balance after a provider billing full-time care during school hours). The follow-on Recoupment and Policy action is what child-care provider integrity lead does next: implement the option, assign an owner, and log the missing fact.