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20.4 Questionable Items 20.4.1 Questionable Items Introduction Information is questionable when: 1. There are inconsistencies in the group’s oral or written statements. 2. There are inconsistencies between the group’s claims and collateral contacts, documents, or prior records. 3. The member or his or her representative is unsure of the accuracy of his or her own statements. 4. The member has been convicted of Medicaid member fraud or has legally acknowledged his or her guilt of member fraud. 5. The member is a minor who reports that he or she is living alone. This does not apply to minors applying solely for FPOS. 6. Unclear or vague (i.e., information provided, but not clear). 20.4.2 Tuberculosis See BadgerCare Plus Handbook, Chapter 43 Tuberculosis-Related Medicaid for appropriate verification items if information provided is questionable. 20.4.3 Farm and Self-Employment Income See SECTION 15.6.6 VERIFICATION for appropriate verification items if information provided is questionable. This page last updated in Release Number: 19-02 Release Date: 9/10/2019 Effective Date: 9/10/2019 20.5 Member Responsibility Assist the Member The IM worker has a responsibility to use all available data exchanges to verify information, but the member has primary responsibility for providing verification. The member must likewise resolve questionable information. Do not deny eligibility when the member does not have the ability to produce verification. Assist the member in obtaining verification if he or she has difficulty in obtaining it. Use the best information available to process the application or change within the time limit and issue benefits when the following two conditions exist: 1. The member does not have the power to produce verification, and 2. Information is not obtainable timely even with your assistance. In this situation, seek verification later. When you have received the verification, you may need to adjust or recoup benefits based on the new information. Explain this to the member when requesting verification.