Detection is a commodity.
Admissible proof is the moat.
This is where JIL goes deepest—Medicare, Medicaid, MCO payment integrity, RADV—not because the company is CMS-only, but because this is the market where flags without proof burn institutions every day. Legacy vendors hand you spreadsheets of “suspected overpayments.” JIL turns every claim decision into a self-authenticating, court-ready case file at capture. Same engine as public funds and other domains; healthcare is the bread and butter.
Claims, encounters, and payment instructions originate in current plan systems—no rail replacement.
Identity, exclusions, policy, and documentation support scoring run in parallel. Horizon Aegis runs continuous shadow RADV on V22/V24; V28 stays ready, not active.
Clean items proceed. Exceptions route to SIU with evidence spans. High-confidence adverse paths draft CREB™ packages.
Existing rails move money. Sealed CREB/AREB records remain institution-owned for audit, MFCU, and counsel handoff.
Why legacy payment integrity fails in court
Healthcare payors lose millions in overpayment recovery not because the fraud isn’t real, but because the evidence produced by vendor analytics cannot survive legal discovery.
Spreadsheets are not cases
Standard tools supply flagged lists. When a provider challenges a clawback, counsel still must authenticate origin, preserve custody, and prove nothing was altered—often months of work after the “finding.”
Captive conflict of interest
When audit tech is owned by a competing plan or provider network, findings are inherently discounted. JIL owns no health plan and no provider network—the record is neutral infrastructure the institution owns.
What JIL delivers
Pre-settlement verification plus sealed CREB™ / AREB packages: adverse recovery path and affirmative audit defense on one ledger—without replacing ACH, RTP, or bank-controlled rails.
From flagged claim to court-ready evidence in seconds
In Medicaid managed care and Medicare Advantage, contingency vendors hand you a list of suspected overpayments. Legal still spends months on data origin. JIL seals every claim decision under FRE 902(14) at capture—when MFCU or counsel asks for proof, you transfer a CREB™, not a CSV.
Phantom providers
Enrollment, identity, and claim-pattern evidence sealed at capture for schemes that never rendered services.
DMEPOS upcoding
Durable medical equipment coding and utilization vectors packaged for SIU and recovery with chain of custody intact.
Hospice cap fraud
Cap and eligibility integrity with AREB/CREB packaging for plan audit defense and adverse recovery paths.
Pharmacy & 340B arbitrage
Cross-claim pharmacy and 340B-related patterns where documentation gaps become court-ready evidence bundles.
Horizon Aegis · RADV
Continuous shadow RADV on V22/V24. CREB-RADV, AREB-RADV, PIEB-RADV, and RREB-RADV profiles — audit response starts sealed, not from chart archaeology. V28 is ready, not active.
Horizon Aegis SIU workbench
Operator surface: SIU queue, documentation-support calibration, sample stress. Shadow by default. Not adjudication.
Why competing vendors cannot deliver court-grade proof
Evidence produced by a captive subsidiary of a competing plan or provider network is inherently discounted. JIL owns zero health plans, operates no provider networks, and takes no contingency cuts. We are the neutral referee—the record is yours.
MCO 5 bps · hospital 0.25% NPR · hospice 1%
Many payment integrity vendors still bill per case, per chart hour, or take a contingency cut of recovery. JIL does not. Healthcare PI is 5 bps flat for MCOs, 0.25% of NPR for hospitals, and 1% for hospice—Horizon Aegis, V22/V24 scoring, and sealed CREB™ / AREB / PIEB / RREB included. You keep 100% of recoveries. Not 35-90.
Included in the rate
Horizon Aegis shadow RADV, SIU prioritization, V22/V24 scoring, and sealed CREB/AREB/PIEB/RREB for in-scope findings—not sold one-by-one after the queue fills.
Never part of the deal
No contingency on recoveries. No per-finding tax. No CAPEX project. No surprise per-bundle invoices. Rate is by buyer type, not a 35-90 band.
Procurement-friendly
Pricing lives in the MSA by buyer type: MCO 5 bps flat, hospital 0.25% NPR, hospice 1%. Diligence is three rates, not a recovery-share spreadsheet.
A finding versus a court-ready case file
| Capability | Legacy vendors | JIL Sovereign (CREB™) |
|---|---|---|
| Primary output | CSV / flagged finding | Self-authenticating evidence bundle |
| Legal posture | Often needs foundation testimony | FRE 902(14)-oriented seal + hash anchor |
| Chain of custody | Rebuilt under audit pressure | Sealed at capture |
| MFCU / counsel handoff | Months of discovery | Filing-ready package path |
| Neutrality | Often captive to a plan network | Independent infrastructure; customer owns the record |
Prove what went wrong. Defend what went right.
Most suites only hunt bad actors. For MCOs and agencies, proving compliance is as critical as uncovering fraud—especially under RADV and routine audit pressure.
CREB™ — Court Ready Evidence Bundle
Seals overpayments, unsupported risk adjustment, phantom schemes, and related adverse findings into packages oriented for recovery, SIU escalation, and counsel handoff under FRE 902(14).
AREB — Audit-Ready Evidence Bundle
Proves payments that cleared under policy and governing rules as of the service date—with exceptions stated—so clean cohorts are not left without affirmative proof.
RADV profiles · Horizon Aegis
CREB-RADV, AREB-RADV, PIEB-RADV, and RREB-RADV (RRADV) are profiles of the four bundles — not a fifth engine. Horizon Aegis scores V22/V24 live. V28, MEAT, and B11 stay ready, not active.
V22/V24 is what CMS audits today. V28 is ready, not active.
Horizon Aegis is continuous shadow RADV readiness — SIU work-queue, documentation-support calibration, sample stress. It does not adjudicate claims and it does not move money. Briefings can be thorough on current RADV without selling a payment-year transition as live law.
V22 / V24 · live
The HCC models CMS uses on current RADV audits. Horizon Aegis scores documentation support against these models. Sample packages in the Implementation Guide use V24.
V28 · ready, not active
Coded for the payment-year transition. Flag defaults off. Not the model of a current RADV audit and not sold as a live CMS mandate.
MEAT / B11 · ready, not active
MEAT is an AAPC/CDI mnemonic, not CMS RADV law. B11 extrapolation is a self-ID / reserve scenario — the 2023 RADV Final Rule nationwide extrapolation was vacated in Humana v. Becerra.
The four RADV packages: CREB-RADV, AREB-RADV, PIEB-RADV, RREB-RADV · Horizon Aegis product · SIU workbench
Your data never leaves your enclave
JIL deploys natively against customer Snowflake or Databricks estates. Protected health information stays in the customer boundary; cryptographic digests may anchor to CourtChain™ without shipping charts offsite.
Snowflake
In-account detection and evidence jobs. Zero PHI egress for core evaluation paths.
Databricks
Unity Catalog–aligned pipelines for claim and encounter validation at plan scale.
JIL dedicated enclave
Isolated sovereign environment for agency and MFCU-style deployments when required.
$87.1B in improper payments. 79% caused by a documentation gap.
CMS reported $87.1B in improper payments in FY2024 across Medicare, Medicaid, CHIP, and ACA programs. The data is clear: these are not detection failures -- they are structural gaps where the payment cleared before documentation was verified.
~100% attributable to absent pre-payment gate
- 79% of Medicaid improper payments: insufficient documentation (CMS FY2024)
- Medicare Fee-for-Service: $31.7B improper -- 7.66% rate for eighth consecutive year
- Remaining 21%: unenrolled providers, wrong amounts -- also attestation-preventable
- GAO: 100+ CMS recommendations unimplemented including pre-payment review
The payment cleared without verification -- not because fraud was cleverly concealed, but because the documentation gate does not exist before settlement. JIL adds that gate: SDV documentation binding, provider enrollment checks, and claim corridor enforcement before any payment is released.
Sources: CMS HHS Agency Financial Report FY2024; GAO FY2024 ($162B federal improper payments); AFP 2025 Payments Fraud and Control Survey.
What JIL Verifies Before Payment Release
- Provider identity and enrollment: verify the provider is enrolled, licensed, and not excluded before the payment instruction is approved
- Documentation tokenization: bind supporting documentation to the payment via the Secure Document Vault -- no document, no payment
- Claim corridor enforcement: flag out-of-pattern amounts, duplicate claims, and claims that exceed policy thresholds before release
- Sanctions and exclusions: real-time screening against OIG exclusion lists, OFAC, and state-level debarment databases
- Routing and account integrity: confirm payment routing matches the attested provider record -- block substituted or modified bank accounts
Use the Calculator Below
Enter your institution's payment volume and leakage rate to see the financial case for adding a pre-settlement attestation layer. The industry baseline above suggests that the vast majority of healthcare improper payments are structurally preventable.
Estimate the financial case in under a minute.
Use your own assumptions. This model focuses on payment leakage reduction and labor savings from exception handling. Adjust the inputs below to fit your environment.
This illustrative model does not include secondary value from stronger CMS audit readiness, faster exception resolution, reduced provider abrasion, or avoided downstream recovery efforts.
Start with a narrow proof of concept.
Duration: 2-4 weeks
Scope: one payment class, one provider segment, or one regional payment workflow
Outputs: exception rate, routing mismatches, documentation gaps, policy violations, and estimated savings
Integration: API-based, low disruption, current payment rails remain in place
What we verify before release
- Provider identity and entity matching
- Exclusion and sanctions checks
- Routing and account integrity validation
- Policy and threshold enforcement
- Verification receipt for every approved payment
Request an Evidence Audit
Architecture, Horizon Aegis (V22/V24 live; V28 ready, not active), PI rates (MCO 5 bps / hospital 0.25% NPR / hospice 1%), and a synthetic MCO claims walkthrough for compliance, SIU, finance, and counsel.