Assess whether a SAR narrative is supportable today from synthetic identity

Situation

After three applications sharing one employer EIN and no payroll, synthetic identity application cluster is what claims special-investigation lead can touch in a Medicare Advantage claims shop. Fraud Detection will live with Remove access or reverse the item versus Temporary compensating control on this Credit and Identity Fraud file.

Decision

Claims special-investigation lead 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 three applications sharing one employer EIN and no payroll.

Hypotheses to test

• Synthetic identity application cluster reads as Remove access or reverse the item once three applications sharing one employer EIN and no payroll is lined up to the same Fraud Detection population.
• Synthetic identity application cluster is closer to Temporary compensating control after three applications sharing one employer EIN and no payroll; Remove access or reverse the item would over-claim this Credit and Identity Fraud extract.
• Approve a documented exception is still live in synthetic identity application cluster for claims special-investigation lead in a Medicare Advantage claims shop.
• Synthetic identity application cluster is missing the fact claims special-investigation lead needs after three applications sharing one employer EIN and no payroll; stop this Fraud Detection close.

Analysis required

• Map typology and hold authority claims special-investigation lead actually has in a Medicare Advantage claims shop.
• Trace funds, counterparties, and reversals in synthetic identity application cluster through the window opened by three applications sharing one employer EIN and no payroll.
• Quantify loss if the hold is released before synthetic identity application cluster is complete.
• For this Fraud Detection Credit and Identity Fraud file, read synthetic identity application cluster against three applications sharing one employer EIN and no payroll and write the one fact that would move a SAR narrative is for claims special-investigation lead.

Recommendation

Choose Remove access or reverse the item / Temporary compensating control / Approve a documented exception / Hold on this Fraud Detection / Credit and Identity Fraud packet (synthetic identity application cluster after three applications sharing one employer EIN and no payroll). The follow-on Credit and Identity Fraud action is what claims special-investigation lead does next: implement the option, assign an owner, and log the missing fact.