The process of referring a case in the quality review component is different from
the DDS. If potential FSF is identified during review, the reviewer will refer via
an e8551, (the referral of a potential fraud violation).
NOTE: In section V.C of the e8551, quality reviewers leave the section blank.
If the case needs to be returned for a deficiency, instruct the DDS to refer the case
for FSF investigation per guidelines in DI 23025.015.
If there is no returnable deficiency present, follow these steps:
Consult with a member of management to ensure appropriateness and completeness of
Effectuate the claim and send the appropriate personalized notices (if applicable)
to the claimant and any representatives. NOTE: If the IU decides to accept the case for investigation, clearing the case from the
legacy system will not cease the process.
Forward the case to the appropriate office (field office or payment center) with an
alert in the file explaining that there is a pending referral.
NOTE: Do not hold the case in the quality review component after making a fraud referral.
See GN 04124.001 for access to the form
For further instructions on preparing the e8551, see GN 04111.065
See potential high-risk FSF indicators per DI 23025.005.