Assess whether to refer to law enforcement or keep civil (7f1e7c)

SITUATION In a P&C carrier's auto-body network, Medicare upcoding CPT pairing table is the evidence after a clinic billing the same modifier on 80% of visits. SIU investigator has to pick To refer to law enforcement or Keep civil for this Fraud Detection Mortgage Fraud close using Medicare upcoding CPT pairing table.

DECISION SIU investigator in a P&C carrier's auto-body network must choose To refer to law enforcement / Keep civil using Medicare upcoding CPT pairing table after a clinic billing the same modifier on 80% of visits.

HYPOTHESES TO TEST 1. A clinic billing the same modifier on 80% of visits is noise around an already-controlled Mortgage Fraud process in a P&C carrier's auto-body network, given Medicare upcoding CPT pairing table. 2. A clinic billing the same modifier on 80% of visits is the event in Medicare upcoding CPT pairing table that forces To refer to law enforcement for SIU investigator under Fraud Detection. 3. Medicare upcoding CPT pairing table shows a one-file miss after a clinic billing the same modifier on 80% of visits, not a Mortgage Fraud program failure. 4. Medicare upcoding CPT pairing table cannot decide to refer to law yet after a clinic billing the same modifier on 80% of visits; hold is the only Fraud Detection close a P&C carrier's auto-body network can defend.

ANALYSIS REQUIRED 1. Check mule or round-trip markers in Medicare upcoding CPT pairing table. 2. Map typology and hold authority SIU investigator actually has in a P&C carrier's auto-body network. 3. Trace funds, counterparties, and reversals in Medicare upcoding CPT pairing table through the window opened by a clinic billing the same modifier on 80% of visits. 4. For this Fraud Detection Mortgage Fraud file, read Medicare upcoding CPT pairing table against a clinic billing the same modifier on 80% of visits and write the one fact that would move to refer to law for SIU investigator.

RECOMMENDATION Choose To refer to law enforcement / Keep civil on this Fraud Detection / Mortgage Fraud packet (Medicare upcoding CPT pairing table after a clinic billing the same modifier on 80% of visits). Lead with the Fraud Detection option Medicare upcoding CPT pairing table 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 SIU investigator in a P&C carrier's auto-body network.

COMMAND RETURNS - Bottom-line Fraud Detection option on to refer to law, then the evidence in Medicare upcoding CPT pairing table, then the action for SIU investigator - Hypothesis scorecard against Medicare upcoding CPT pairing table: supported / rejected / untestable - Owner and next date for SIU investigator in a P&C carrier's auto-body network - What changes to refer to law if a clinic billing the same modifier on 80% of visits is later withdrawn