A Medicaid finding needs a file, not another flag.

The job is the file, not a national percentage

Medicaid improper payment is a proof problem. A plan, a state program-integrity office, or counsel has to show who was paid, why that payment was improper, and which evidence supports the finding. A slide that quotes a national rate does not do that work. This page does not invent a rate, a recovery total, or a state-by-state scoreboard. If a number is not in the file for the claim in front of you, it does not belong in the brief.

State Medicaid program integrity is already in the field with recovery actions. Finding letters have to stand up later, when the provider, the hearing, or counsel asks for the record behind the letter. The same pressure sits on Medicare Advantage, which is why the health-plan page treats audit risk and improper-payment recovery as one evidence problem. The Medicaid file uses the same factory.

What the evidence has to show

Federal and state program-integrity buyers ask a plain question: who got paid, on what basis, and with what evidence. The answer is not a black-box score. It is a sealed record. CREB is the court-ready cover when the finding is adverse and someone may have to prove it. PIEB is the payer's own payment-integrity record. RREB, the Risk and Recovery Evidence Bundle, is the non-legal brief for recovery operations, with sample-only exposure, not a booked government recovery. AREB is the file that shows what the record supports, which matters when the dispute is "you had the support and you ignored it."

The seal is the same fabric on each cover: the check that fired, evidence hashes, a hybrid seal (Ed25519 and ML-DSA-65), multi-party confirmation, and a chain of custody. The design is a customer-held vault, with retention measured in a 15-year-plus design, and a file that can be checked without JIL Sovereign Technologies, Inc. in the room and without our live cooperation. A court decides whether to admit it. No department has approved the form. Do not tell a state agency that approval exists.

Plan side and provider side do not share a file

PIEB is plan-side. A provider-side engagement cannot pull it. The separation is fail-closed. That is deliberate. A payer integrity record and a provider defense are different allegiances. Reusing one as the other is how a file gets attacked as somebody's advocacy instead of read as a record. If you are the plan, you get the payer file. If you are defending a chart, you are in AREB territory, not in a borrowed PIEB.

Ava can draft the RADV profiles of the four bundles. Those profiles are CREB-RADV, AREB-RADV, PIEB-RADV, and RREB-RADV. They are not a Medicaid-specific fifth engine, and they are not a separate Ava Pro. Live HCC scoring, where the matter is Medicare Advantage risk adjustment rather than a Medicaid claim, is V22 and V24. V28 is ready, not active. Do not brief a Medicaid team with a V28 story as if CMS were auditing today's Medicare sample on V28. The model page is V22 and V24 live.

Where a state MFCU fits

A state Medicaid Fraud Control Unit is a recipient, not a co-author. SIU and counsel decide whether to refer. What they can hand over is the sealed file the institution owns, not a login and not a vendor score. This company does not file the referral, does not appear as the complainant, and does not say a unit has accepted the template. The package, and the limits on what it is, are on the MFCU referral package. What counsel actually receives, cover by cover, is on what counsel receives.

RREB is the wrong document to dress up as a charging packet. It is a non-legal recovery brief. CREB is the court-oriented file. If counsel wants both, label them. Mixing the covers is how a recovery worksheet gets described, later, as if it were the case.

Related fights, same seal

Pharmacy and 340B disputes are a neighboring improper-payment problem: duplicate discount, contract-pharmacy depth, off-label dispensation. JIL Sovereign Technologies, Inc. does not pick the manufacturer, the payer, or the covered entity. Each party can be handed the same sealed file. That neutrality is the point, and it is not a Medicaid rate. The detail is pharmacy and 340B. Broader public-money questions, vendors and beneficiaries and why the dollar left, sit on federal spending integrity.

None of those pages is a license to invent a recovered-dollar total. Demonstrations are not customers. A redacted walkthrough is a walkthrough. If you need the Medicare chart version of "seal it before the letter," start at the sample letter and stopping the improper payment.

Checks, price, and the company line

332 checks are active. The catalog holds 489, including registered definitions that are not all executing. The live path is deterministic. A check runs, skips with a reason, or fails closed. Ava groups and narrates. It does not send the customer's data to a public chatbot. Shadow mode does not touch the rail. A person decides.

Healthcare payment integrity is MCO minimal OPEX in basis points, hospital 0.25% of net patient revenue, and hospice 1%. No contingency. The customer keeps the recoveries. Federal and state work outside that healthcare line is scoped per engagement. It is still not a share of recoveries. This company does not operate the Layer-1 or the wallet. Those belong to JIL Federation Technologies, Inc. at jilsovereign.net and getjil.com. Holdings is the licensor and has no product site.

FAQ

Do you publish a Medicaid improper-payment percentage?

No. This page does not state a national rate or a recovery total. The work is the file for the payment in front of you: who was paid, why, and with what evidence.

Which bundle does a Medicaid plan use?

PIEB for the plan's own payment-integrity record, CREB when the finding has to be proved, AREB when the point is what the record supports, and RREB for a non-legal recovery brief. RADV profiles of those four are not a fifth engine.

Can a provider engagement pull the plan's PIEB?

No. PIEB is plan-side. A provider-side engagement is refused. The separation is fail-closed so a payer file is not reused as a provider defense.

Will a state MFCU accept this as an approved form?

Do not say that. No department has approved the form. Counsel decides whether to refer. The unit and the court decide what they do with the file. A court decides what it admits.

Is Medicaid priced as a percent of recoveries?

No. Healthcare payment integrity is MCO minimal OPEX in basis points, hospital 0.25% of net patient revenue, and hospice 1%. No contingency. The customer keeps the recoveries.