FAA6.F Administrative : 05 Office of Special Investigations (OSI)/AHCCCS Office of Inspector General (AOIG) : D OSI - Acting on OSI Reports of Investigation (ROI) : .03 Acting on OSI Reports of Investigation – Violations Found
Acting on OSI Reports of Investigation – Violations Found
 
(01/01/22 – 12/31/22)
The Customer Care Center (CCC) Tucson B, site code 281C, mail drop 33N3 is to receive and process the Report of Investigation (ROI) with violations found for cases when both of the following apply:
 
●The case contains CA or NA
●The case is either closed or active and not pending an application.
 
All other ROIs for cases where violations are found are to be sent to the local office or hospital that requested the investigation for processing. This includes, but is not limited to, the ROIs for all cases with pending applications (initial or renewal).
 
When the Violations Found box is checked or indicated on the ROI, determine whether additional mandatory verification is needed.
 
(See Information Needed for policy on requesting required verification.)
 
When the ROI is returned on a pending case and additional information is not needed, complete the eligibility determination. Review all information and verification provided by the participant or the investigators and determine its impact on the determination.
 
When the ROI is returned on an active case and additional information is not needed, take appropriate action to complete any necessary changes. For instructions on processing changes see Effecting Changes.
 
Send the Notice of Investigation (C023) notice with any adverse action.
 
Document the case file(g) with a summary of the actions taken on the case.