Assess whether a provider should be suspended pending SIU (52fae3)

Situation

A Medicare Advantage claims shop cannot treat a new device from a different metro on a 2am login as color commentary on synthetic identity application cluster. Bank BSA/AML case manager must close a provider should be from that extract under Fraud Detection / Payments Fraud.

Decision

Bank BSA/AML case manager in a Medicare Advantage claims shop must choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold using synthetic identity application cluster after a new device from a different metro on a 2am login.

Hypotheses to test

• The population in synthetic identity application cluster is the one a new device from a different metro on a 2am login named, so Remove access or reverse the item follows for this Payments Fraud file.
• The population in synthetic identity application cluster is adjacent only to a new device from a different metro on a 2am login; Temporary compensating control is the honest Fraud Detection call.
• A Medicare Advantage claims shop already contained a new device from a different metro on a 2am login before synthetic identity application cluster arrived; no new Payments Fraud path.
• Provenance on synthetic identity application cluster after a new device from a different metro on a 2am login is broken; do not pick Remove access or reverse the item or Temporary compensating control yet.

Analysis required

• Trace funds, counterparties, and reversals in synthetic identity application cluster through the window opened by a new device from a different metro on a 2am login.
• Quantify loss if the hold is released before synthetic identity application cluster is complete.
• Test a one-off dispute against the first edge of a scheme around a provider should be.
• For this Fraud Detection Payments Fraud file, read synthetic identity application cluster against a new device from a different metro on a 2am login 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 / Payments Fraud packet (synthetic identity application cluster after a new device from a different metro on a 2am login). The follow-on Payments Fraud action is what bank BSA/AML case manager does next: implement the option, assign an owner, and log the missing fact.