Assess whether an eligibility case is error, fraud, or both (6666c1)

Situation

After a TANF case with unsigned work-activity forms, disability CDR medical-evidence pack is what disability continuing-eligibility reviewer can touch in a disability unit facing a backlog of CDRs. Public Benefits will live with An eligibility case is error, fraud, versus Both on this Compliance and Integrity Operations file.

Decision

Disability continuing-eligibility reviewer in a disability unit facing a backlog of CDRs must choose An eligibility case is error, fraud, / Both using disability CDR medical-evidence pack after a TANF case with unsigned work-activity forms.

Hypotheses to test

• The population in disability CDR medical-evidence pack is the one a TANF case with unsigned work-activity forms named, so An eligibility case is error, fraud, follows for this Compliance and Integrity Operations file.
• The population in disability CDR medical-evidence pack is adjacent only to a TANF case with unsigned work-activity forms; Both is the honest Public Benefits call.
• A disability unit facing a backlog of CDRs already contained a TANF case with unsigned work-activity forms before disability CDR medical-evidence pack arrived; no new Compliance and Integrity Operations path.
• Provenance on disability CDR medical-evidence pack after a TANF case with unsigned work-activity forms is broken; do not pick An eligibility case is error, fraud, or Both yet.

Analysis required

• 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.
• Match household facts in disability CDR medical-evidence pack to the rule that pays the benefit.
• For this Public Benefits Compliance and Integrity Operations file, read disability CDR medical-evidence pack against a TANF case with unsigned work-activity forms and write the one fact that would move an eligibility case is for disability continuing-eligibility reviewer.

Recommendation

Choose An eligibility case is error, fraud, / Both on this Public Benefits / Compliance and Integrity Operations packet (disability CDR medical-evidence pack after a TANF case with unsigned work-activity forms). The follow-on Compliance and Integrity Operations action is what disability continuing-eligibility reviewer does next: implement the option, assign an owner, and log the missing fact.