Assess whether to refer to law enforcement or keep civil (cc0469)

SITUATION A workers'-comp insurer after a surge in CT claims has mule-account payroll deposit pattern in hand following a check deposited in two banks the same afternoon. Wire-desk escalation officer must determine whether to refer to law enforcement or keep civil for this Fraud Detection Claims and Benefits Fraud file.

DECISION Wire-desk escalation officer in a workers'-comp insurer after a surge in CT claims must choose To refer to law enforcement / Keep civil using mule-account payroll deposit pattern after a check deposited in two banks the same afternoon.

HYPOTHESES TO TEST 1. A check deposited in two banks the same afternoon is noise around an already-controlled Claims and Benefits Fraud process in a workers'-comp insurer after a surge in CT claims, given mule-account payroll deposit pattern. 2. A check deposited in two banks the same afternoon is the event in mule-account payroll deposit pattern that forces To refer to law enforcement for wire-desk escalation officer under Fraud Detection. 3. Mule-account payroll deposit pattern shows a one-file miss after a check deposited in two banks the same afternoon, not a Claims and Benefits Fraud program failure. 4. Mule-account payroll deposit pattern cannot decide to refer to law yet after a check deposited in two banks the same afternoon; hold is the only Fraud Detection close a workers'-comp insurer after a surge in CT claims can defend.

ANALYSIS REQUIRED 1. Test a one-off dispute against the first edge of a scheme around to refer to law. 2. Check mule or round-trip markers in mule-account payroll deposit pattern. 3. Map typology and hold authority wire-desk escalation officer actually has in a workers'-comp insurer after a surge in CT claims. 4. For this Fraud Detection Claims and Benefits Fraud file, read mule-account payroll deposit pattern against a check deposited in two banks the same afternoon and write the one fact that would move to refer to law for wire-desk escalation officer.

RECOMMENDATION Choose To refer to law enforcement / Keep civil on this Fraud Detection / Claims and Benefits Fraud packet (mule-account payroll deposit pattern after a check deposited in two banks the same afternoon). The follow-on Claims and Benefits Fraud action is what wire-desk escalation officer does next: implement the option, assign an owner, and log the missing fact.

COMMAND RETURNS - Bottom-line Fraud Detection option on to refer to law, then the evidence in mule-account payroll deposit pattern, then the action for wire-desk escalation officer - Hypothesis scorecard against mule-account payroll deposit pattern: supported / rejected / untestable - Claims and Benefits Fraud finding in mule-account payroll deposit pattern that a second reviewer can re-perform - Missing page in mule-account payroll deposit pattern after a check deposited in two banks the same afternoon, if any