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JLN Process - Manage fraudulent cases

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Created by tabea.boateng, last modified on Feb 17, 2020

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Process Group

Audit/Fraud Management

Objective

Manage identified cases of suspicious program benefit utilization to closure

Input

List of suspected cases
Inquiries
Evidence

Output

Corrective action (i.e., remove beneficiary, remove provider, file charges with court)

Measurable Outcomes

List of verified fraudulent claims
Plan of corrective actions

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