Assess whether an eligibility case is error, fraud, or both (814b9b)

Situation

Issuance-system integrity manager in a child-care subsidy program with related-provider clusters has one working extract — retailer trafficking red-flag report — after a MAGI mismatch that could be a household-size coding error. If retailer trafficking red-flag report cannot support an eligibility case is, the honest Public Benefits output is hold.

Decision

Issuance-system integrity manager in a child-care subsidy program with related-provider clusters must choose An eligibility case is error, fraud, / Both using retailer trafficking red-flag report after a MAGI mismatch that could be a household-size coding error.

Hypotheses to test

• Retailer trafficking red-flag report reads as An eligibility case is error, fraud, once a MAGI mismatch that could be a household-size coding error is lined up to the same Public Benefits population.
• Retailer trafficking red-flag report is closer to Both after a MAGI mismatch that could be a household-size coding error; An eligibility case is error, fraud, would over-claim this Compliance and Integrity Operations extract.
• A dual reading is still live in retailer trafficking red-flag report for issuance-system integrity manager in a child-care subsidy program with related-provider clusters.
• Retailer trafficking red-flag report is missing the fact issuance-system integrity manager needs after a MAGI mismatch that could be a household-size coding error; stop this Public Benefits close.

Analysis required

• Test eligibility, recoupment, and improper-payment facts in retailer trafficking red-flag report after a MAGI mismatch that could be a household-size coding error.
• Quantify overpayment if an eligibility case is is wrong.
• Separate a case-level error from a program-design failure in a child-care subsidy program with related-provider clusters.
• For this Public Benefits Compliance and Integrity Operations file, read retailer trafficking red-flag report against a MAGI mismatch that could be a household-size coding error and write the one fact that would move an eligibility case is for issuance-system integrity manager.

Recommendation

Choose An eligibility case is error, fraud, / Both on this Public Benefits / Compliance and Integrity Operations packet (retailer trafficking red-flag report after a MAGI mismatch that could be a household-size coding error). The follow-on Compliance and Integrity Operations action is what issuance-system integrity manager does next: implement the option, assign an owner, and log the missing fact.