Assess whether to refer to law enforcement or keep civil (c1f143)

SITUATION After a clinic billing the same modifier on 80% of visits, BEC wire instruction-change email thread is what bank BSA/AML case manager can touch in a Medicare Advantage claims shop. Fraud Detection will live with To refer to law enforcement versus Keep civil on this Payments Fraud file.

DECISION Bank BSA/AML case manager in a Medicare Advantage claims shop must choose To refer to law enforcement / Keep civil using BEC wire instruction-change email thread after a clinic billing the same modifier on 80% of visits.

HYPOTHESES TO TEST 1. Authorize To refer to law enforcement now; BEC wire instruction-change email thread already has the discriminator after a clinic billing the same modifier on 80% of visits. 2. Keep Keep civil in force until BEC wire instruction-change email thread is completed after a clinic billing the same modifier on 80% of visits for bank BSA/AML case manager. 3. Treat BEC wire instruction-change email thread as To refer to law enforcement because both readings appear after a clinic billing the same modifier on 80% of visits. 4. Refuse a Fraud Detection close: bank BSA/AML case manager does not have the decision to refer to law turns on in BEC wire instruction-change email thread.

ANALYSIS REQUIRED 1. Map typology and hold authority bank BSA/AML case manager actually has in a Medicare Advantage claims shop. 2. Trace funds, counterparties, and reversals in BEC wire instruction-change email thread through the window opened by a clinic billing the same modifier on 80% of visits. 3. Quantify loss if the hold is released before BEC wire instruction-change email thread is complete. 4. For this Fraud Detection Payments Fraud file, read BEC wire instruction-change email thread against a clinic billing the same modifier on 80% of visits 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 (BEC wire instruction-change email thread after a clinic billing the same modifier on 80% of visits). Lead with the Fraud Detection option BEC wire instruction-change email thread can support after a clinic billing the same modifier on 80% of visits, then the two facts that force it, then the Monday action for bank BSA/AML case manager in a Medicare Advantage claims shop.

COMMAND RETURNS - Bottom-line Fraud Detection option on to refer to law, then the evidence in BEC wire instruction-change email thread, then the action for bank BSA/AML case manager - Hypothesis scorecard against BEC wire instruction-change email thread: supported / rejected / untestable - Payments Fraud finding in BEC wire instruction-change email thread that a second reviewer can re-perform - Missing page in BEC wire instruction-change email thread after a clinic billing the same modifier on 80% of visits, if any