Assess whether threshold splitting is a procurement-integrity issue (b2fb24)

Situation

In a Medicare contractor SIU pack, improper-payment sample that will not extrapolate cleanly is the evidence after a SAR the institution filed late after a wire already left. HHS-OIG health-fraud analyst has to pick Pursue or Pursue with conditions for this US Federal Banking Regulation and Model Risk close using improper-payment sample that will not extrapolate cleanly.

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 SAR the institution filed late after a wire already left.

Hypotheses to test

• The population in improper-payment sample that will not extrapolate cleanly is the one a SAR the institution filed late after a wire already left named, so Pursue follows for this Banking Regulation and Model Risk file.
• The population in improper-payment sample that will not extrapolate cleanly is adjacent only to a SAR the institution filed late after a wire already left; Pursue with conditions is the honest US Federal call.
• A Medicare contractor SIU pack already contained a SAR the institution filed late after a wire already left before improper-payment sample that will not extrapolate cleanly arrived; no new Banking Regulation and Model Risk path.
• Provenance on improper-payment sample that will not extrapolate cleanly after a SAR the institution filed late after a wire already left is broken; do not pick Pursue or Pursue with conditions yet.

Analysis required

• Normalize pricing and CPARS/QASP evidence that actually supports threshold splitting is a.
• 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 SAR the institution filed late after a wire already left and write the one fact that would move threshold splitting is a 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 SAR the institution filed late after a wire already left). The follow-on Banking Regulation and Model Risk action is what HHS-OIG health-fraud analyst does next: implement the option, assign an owner, and log the missing fact.