Hand the MFCU a file a person can explain.

MFCU is the recipient. Counsel is the sender.

A state Medicaid Fraud Control Unit receives what the plan's counsel and SIU choose to hand over. It does not receive a vendor account, and it does not receive a score with a color on it. The package is the sealed file the institution already owns. This company does not make the referral, does not sign it, and does not tell you a unit has accepted a template. If someone on a sales call says a department approved the file, that sentence is false.

The title of this page uses MFCU because that is the name the unit uses. The work behind the handoff is the same evidence factory as the rest of the payment-integrity line: CREB when the facts have to be proved, not a special "referral engine" with its own catalog. Background on the Medicaid file, without an invented improper-payment rate, is Medicaid improper-payment evidence.

What you can put in the envelope

Use CREB, the Court Ready Evidence Bundle, when the point of the referral is an adverse finding counsel is willing to explain. Inside it: the check that fired, the evidence hashes, the hybrid seal (Ed25519 and ML-DSA-65), multi-party confirmation, and the chain of custody. The design assumes the customer holds the vault. A reader can verify the file without our live cooperation. That is what "you can explain it without us in the room" means. If the unit calls and the only answer is "log into the portal," the package was not finished.

Say what the check was. 332 checks are active. The catalog holds 489, including registered definitions that are not all executing. The file should name the check that ran, not "the model thought so." Ava may have grouped and narrated the queue. Ava did not adjudicate, and shadow mode did not move the payment. A person did, on the plan's rail, or no payment was stopped. Do not let the referral imply an automated denial that did not happen. SIU's picture is score the risk, do not touch the rail.

What does not belong in the envelope

RREB does not belong there dressed as the case. The Risk and Recovery Evidence Bundle is a non-legal recovery brief. It can carry sample-only exposure for the plan's own operations. It is not a charging document, and it is not a booked government recovery. AREB is the support file, useful if the question is what the chart actually holds, dangerous if it is mislabeled as the accusation. PIEB is the plan's payment-integrity record. It is plan-side. A provider-side engagement cannot pull it. Keep the allegiance straight when you copy a file into a referral.

Do not enclose a nationwide extrapolation as if Humana v. Becerra had left it in force. The case vacated nationwide extrapolation under the 2023 RADV Final Rule. It is not the number to put in front of a unit, a board, or a court. Sample-only exposure on the live models is the honest figure where the matter is Medicare Advantage RADV. Those live models are V22 and V24. V28 is ready, not active. MEAT is not CMS law. None of those sentences changes because the recipient is a Medicaid fraud unit. Overclaiming a Medicare rule does not make a Medicaid referral stronger.

What this company will not do

We will not say the unit opened a case because a file was generated. We will not name a state form number we do not publish. We will not estimate a recovery, a penalty, or a share. We will not describe a demonstration row as a customer. We will not say the court will admit the file. A court decides what it admits. The package is oriented to FRE 902(13) and 902(14). That is an argument counsel may make. It is not a result.

We also will not operate the referral as if we were the plan. The institution owns the package. Counsel, SIU, and the unit are the readers. There is no vault tax for handing the bytes on. If counsel wants the inventory of every cover before they choose one, read what counsel receives.

How the file was supposed to exist before the referral

A referral assembled after the charts have gone cold is the same failure mode as a RADV response that starts when the sample letter arrives. The point of continuous work is that the check, the hashes, and the custody path were sealed while the reason was still in the room. Stopping the improper payment is that decision. Proof, not flags is why a spreadsheet stalls a referral: the unit can flag too. It needs a record.

Public samples, where you want to see the shape without a client's chart, are the RADV sample packages and the redacted walkthrough. They illustrate covers. They are not a referral, and they are not a finding about any named provider.

Price and operator

No contingency. Healthcare payment integrity is MCO minimal OPEX in basis points, hospital 0.25% of net patient revenue, and hospice 1%. The customer keeps the recoveries. The bundles are included. There is no per-referral fee hiding under a different name on this page, and no published numeric basis-point rate.

JIL Sovereign Technologies, Inc. (Delaware) operates this host for payment integrity and court-ready evidence only. It does not operate the Layer-1 or the wallet. Those are JIL Federation Technologies, Inc. at jilsovereign.net and getjil.com. JIL Sovereign Holdings, LLC is the licensor and has no product site. A unit does not need a lesson in that structure, but counsel does, because the seal's operator and the network's operator are not the same company. Plans start at health plans or a briefing.

FAQ

Does JIL file the MFCU referral?

No. SIU and counsel decide whether to refer and what to send. JIL Sovereign Technologies, Inc. seals the file. It does not appear as the complainant and does not submit the referral.

Has a Medicaid Fraud Control Unit approved this template?

No. Do not say a department approved the file. The unit decides what it accepts. A court decides what it admits.

Is RREB the referral document?

No. RREB is a non-legal recovery brief with sample-only exposure. CREB is the court-oriented file for an adverse finding. Label the cover you send.

Does shadow mode mean the claim was already denied?

No. Default mode does not deny a claim and does not touch the payment rail. If a payment stopped, a person stopped it on the plan's rail. The file is the evidence, not the remittance.

Do you keep a share of a Medicaid recovery?

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