Whether to refer to law enforcement or keep civil from ACH return-reason code

Situation

ACH return-reason code R10 spike arrived with an email that matches a known BEC lure almost exactly for bank BSA/AML case manager. That is a Fraud Detection Payments Fraud decision on to refer to law in a Medicare Advantage claims shop.

Decision

Bank BSA/AML case manager in a Medicare Advantage claims shop must choose To refer to law enforcement / Keep civil using ACH return-reason code R10 spike after an email that matches a known BEC lure almost exactly.

Hypotheses to test

• ACH return-reason code R10 spike reads as To refer to law enforcement once an email that matches a known BEC lure almost exactly is lined up to the same Fraud Detection population.
• ACH return-reason code R10 spike is closer to Keep civil after an email that matches a known BEC lure almost exactly; To refer to law enforcement would over-claim this Payments Fraud extract.
• A dual reading is still live in ACH return-reason code R10 spike for bank BSA/AML case manager in a Medicare Advantage claims shop.
• ACH return-reason code R10 spike is missing the fact bank BSA/AML case manager needs after an email that matches a known BEC lure almost exactly; stop this Fraud Detection close.

Analysis required

• Map typology and hold authority bank BSA/AML case manager actually has in a Medicare Advantage claims shop.
• Trace funds, counterparties, and reversals in ACH return-reason code R10 spike through the window opened by an email that matches a known BEC lure almost exactly.
• Quantify loss if the hold is released before ACH return-reason code R10 spike is complete.
• For this Fraud Detection Payments Fraud file, read ACH return-reason code R10 spike against an email that matches a known BEC lure almost exactly and write the one fact that would move to refer to law for bank BSA/AML case manager.

Recommendation

Choose To refer to law enforcement / Keep civil on this Fraud Detection / Payments Fraud packet (ACH return-reason code R10 spike after an email that matches a known BEC lure almost exactly). 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.