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MS 0910 (2) B. Take the following actions when suspected fraud is discovered and the claim meets the criteria in Item A: 1. Calculate the claim based on available verification. 2. Complete form Claim/MA-1, Medical Assistance Eligibility Summary, for claims that include Medicaid. 3. Navigate to the OIG Fraud Claims Tracking SharePoint site and create a new PAFS-88 referral. Enter all relevant claim information in the referral, clearly explain the allegation, and indicate which programs are associated with the overpayment. 4. Upload supporting documentation using the Doc Link hyperlink for the referral. 5. Submit the PAFS-88 referral for supervisor review by updating the referral status. The assigned claims supervisor will review the referral, determine if the referral is appropriate, and ensure all required steps have been completed. The supervisor will have the option to reject the referral or approve and submit the referral for Claims Management Section (CMS) review. 6. CMS reviews the referral and supporting documentation before submitting the referral to OIG on the OIG Fraud Claims Tracking SharePoint site. C. OIG may request a claim to be recalculated based on the findings of the investigation. Complete all recalculations within 15 calendar days of the request by OIG. These computation requests are sent directly to OIG. Contact the OIG investigator and email CMS if there will be a delay in completing computations. D. OIG has a 90-day timeframe to complete the investigation and determine if prosecution will be pursued. 1. If prosecution is not pursued, OIG closes their case and returns the claim to DCBS for administrative action, which must be taken within 10 calendar days. For SNAP claims: a. If fraud is highly suspected, pursue administrative establishment of an Intentional Program Violation (IPV) claim. See MS 1070. b. If the claim was caused by the client but fraud cannot be determined, change the category on the Worker Portal form Suspected Intentional Program Violation (SIPV) and complete as an Inadvertent Household Error Claim (IHE). c. If OIG determines the claim resulted from an Agency Error (AE), review the claim circumstances. The DCBS claims worker determines the appropriate category of a claim. If an AE is found, change the indicator on IEES, and take appropriate action on the claim.