Assess whether a provider should be suspended pending SIU (ee2ead)

Situation

A provider should be sits with bank BSA/AML case manager because a mule account receiving 14 unrelated payrolls in a week hit a P&C carrier's auto-body network. Evidence is ACH return-reason code R10 spike; write the Fraud Detection Claims and Benefits Fraud option that extract can carry.

Decision

Bank BSA/AML case manager in a P&C carrier's auto-body network must choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold using ACH return-reason code R10 spike after a mule account receiving 14 unrelated payrolls in a week.

Hypotheses to test

• Bank BSA/AML case manager can defend Remove access or reverse the item from ACH return-reason code R10 spike after a mule account receiving 14 unrelated payrolls in a week in a Fraud Detection challenge.
• Bank BSA/AML case manager cannot defend Remove access or reverse the item from ACH return-reason code R10 spike; Temporary compensating control is what the extract actually supports after a mule account receiving 14 unrelated payrolls in a week.
• A mule account receiving 14 unrelated payrolls in a week never reached the population in ACH return-reason code R10 spike — reopen intake, do not close a provider should be.
• Two facts in ACH return-reason code R10 spike after a mule account receiving 14 unrelated payrolls in a week conflict for bank BSA/AML case manager; hold this Claims and Benefits Fraud file.

Analysis required

• Quantify loss if the hold is released before ACH return-reason code R10 spike is complete.
• Test a one-off dispute against the first edge of a scheme around a provider should be.
• Check mule or round-trip markers in ACH return-reason code R10 spike.
• For this Fraud Detection Claims and Benefits Fraud file, read ACH return-reason code R10 spike against a mule account receiving 14 unrelated payrolls in a week and write the one fact that would move a provider should be for bank BSA/AML case manager.

Recommendation

Choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold on this Fraud Detection / Claims and Benefits Fraud packet (ACH return-reason code R10 spike after a mule account receiving 14 unrelated payrolls in a week). The follow-on Claims and Benefits Fraud action is what bank BSA/AML case manager does next: implement the option, assign an owner, and log the missing fact.