Assess whether the intrusion is still active (97c760)

Situation

A provider with a sudden modifier-25 spike put improper-payment sample that will not extrapolate cleanly in front of HHS-OIG health-fraud analyst in a Medicare contractor SIU pack. This US Federal / Banking Regulation and Model Risk close is the intrusion is still active from improper-payment sample that will not extrapolate cleanly, and the live options are Pursue, Pursue with conditions, Partner.

Decision

HHS-OIG health-fraud analyst in a Medicare contractor SIU pack must choose Pursue / Pursue with conditions / Partner / No-bid using improper-payment sample that will not extrapolate cleanly after a provider with a sudden modifier-25 spike.

Hypotheses to test

• Authorize Pursue now; improper-payment sample that will not extrapolate cleanly already has the discriminator after a provider with a sudden modifier-25 spike.
• Keep Pursue with conditions in force until improper-payment sample that will not extrapolate cleanly is completed after a provider with a sudden modifier-25 spike for HHS-OIG health-fraud analyst.
• Treat improper-payment sample that will not extrapolate cleanly as Partner because both readings appear after a provider with a sudden modifier-25 spike.
• Refuse a US Federal close: HHS-OIG health-fraud analyst does not have the page the intrusion is still active turns on in improper-payment sample that will not extrapolate cleanly.

Analysis required

• Normalize pricing and CPARS/QASP evidence that actually supports the intrusion is still active.
• Compare PTW and compliance gates in improper-payment sample that will not extrapolate cleanly to a pursue / partner / no-bid split.
• Test OCI and SAM.gov status before a Medicare contractor SIU pack commits.
• For this US Federal Banking Regulation and Model Risk file, read improper-payment sample that will not extrapolate cleanly against a provider with a sudden modifier-25 spike and write the one fact that would move the intrusion is still active for HHS-OIG health-fraud analyst.

Recommendation

Choose Pursue / Pursue with conditions / Partner / No-bid on this US Federal / Banking Regulation and Model Risk packet (improper-payment sample that will not extrapolate cleanly after a provider with a sudden modifier-25 spike). If improper-payment sample that will not extrapolate cleanly cannot force a US Federal label under Banking Regulation and Model Risk, stop. If improper-payment sample that will not extrapolate cleanly after a provider with a sudden modifier-25 spike cannot support Pursue versus Pursue with conditions on this US Federal Banking Regulation and Model Risk close, HHS-OIG health-fraud analyst must identify the Section L/M or evaluation criterion that remains unproven rather than filling the gap.