Detection Series · MCO-INTRO Q2-2026 · Institutional

Court-ready integrity for the post-payment integrity era.

10-slide introduction for the MCO C-suite. What JIL is, the FWEA problem at MCO scale, our three-tier engagement model (Tier 1 detection plus Ava, Tier 2 per-case substantiation, Tier 3 CREB® court-ready bundle), why we are different, how to start a 30-day POC with zero PHI, and the ROI math that pays for the program on case #1.

10 slides For MCO CEO / CFO / CCO / general counsel JIL Sovereign Technologies, Inc.
MCO Introduction · Q2 2026 · Confidential

Court-ready integrity for the post-payment integrity era.

JIL is the cryptographic evidence layer that turns every fraud finding into an FRE 902(14)-eligible Court Ready Evidence Bundle. Non-custodial. Post-quantum. Deterministic.

332
Attestation checks
902(14)
Court-anchored evidence
13
Sovereign jurisdictions
8
Verticals live
JIL Sovereign Technologies, Inc. · jilsovereign.com01 / 10
The MCO Problem · FWEA

Fraud, waste, error, abuse leaks 3-10% of every Medicaid dollar paid.

At 5% of a $130B Medicaid book (Centene FY24 scale), that is $6.5B in flawed claims paid every year. UHG's Medicaid book runs in the same order of magnitude.

The CMS 60-Day Rule turns each one into an False Claims Act exposure if not refunded within 60 days of identification. Penalties run $11K-$22K per claim, trebled, plus a 15-30% qui tam relator share if a relator files first.

Once a relator files, cooperation credit collapses. The clock has already started for every overpayment your SIU has flagged.

$6.5B
Annual FWEA leakage at 5% of a $130B Medicaid book.
Sources: GAO-19-507 · CMS FY2024 improper-payment estimates · 31 USC 3729 · 42 CFR 401.30502 / 10
Our Approach

Detect post-payment. Notify with court-ready proof.

Three engagement tiers plus an agentic-AI middleware. Each finding compounds the next.

Tier 1
Detection scan
Flat-fee. 8 detection categories. Public-data only. No PHI ever crosses the wire.
Ava
Agentic decisioning
Groups suspect cases. Ranks by exposure. Recommends Tier 2 strategy and case-by-case priority.
Tier 2
Per-case substantiation
Goes after the missing facts: bank fingerprints, premise reality, UBO graph, sanctions deltas.
Tier 3
CREB® bundle
Court Ready Evidence Bundle. Hash-anchored, FRE 902(14)-eligible, cryptographically signed and anchored on CourtChain.

We do not move money. We do not take possession of recovered funds. We surface what is wrong, we hand you the FRE 902(13) bundle, and we split our fee 50/50 so half of our economics is tied to your recovery.

Detection-only model · aligned to accuracy, not collection volume03 / 10
The Wedge

Five things every other vendor cannot claim.

  1. No PHI in Tier 1We work entirely from claims metadata plus public-data sources: NPPES, OFAC, OIG LEIE, OpenCorporates, GLEIF, state licensure registries.
  2. Court-ready by defaultEvery finding ships as a CREB® - hash-anchored, cryptographically signed and anchored on CourtChain, self-authenticating under FRE 902(14).
  3. Deterministic and replayableSame inputs always produce the same verdict. Any case can be re-run from any historical snapshot. Nothing is hand-curated.
  4. Half our fee is recovery-tiedAbove the configurable floor we charge 15% of recoverable, split 7.5% at seal + 7.5% at recovery milestone. Below the floor, reports are included in the annual. No per-report a la carte invoices.
  5. Sovereign infrastructure13+ jurisdictions, post-quantum cryptography (Dilithium, Kyber), non-custodial. No single regulator can pull the plug.
Architectural moat, not a marketing claim - audit a CREB® sample to verify04 / 10
High-Level Flow

Profile. Scan. Substantiate.

Three steps. No engineering integration required for the first 30 days.

Step 1
Profile
You define the population. Provider type, geography, claims window, dollar threshold. We call this the PIC: Population, Inclusion criteria, Cohort.
Step 2
Scan
Tier 1 runs 332 attestation checks against the cohort using public data. Ava reviews findings, groups them, recommends Tier 2 strategy.
Step 3
Substantiate
Tier 2 goes after missing evidence on the cases you greenlight. Tier 3 packages the result as a court-ready CREB®.

No PHI in Tier 1. Tokenized provider IDs only. PHI enters scope only on a Tier 2/3 case you authorize.

Decision-maker view · engineering detail in the technical brief05 / 10
POC Playbook

30 days. One cohort. Zero PHI.

  1. Profile (PIC)Pick a high-FWEA-risk cohort: DME, behavioral health, telehealth, home health. Typical scope: 2,000-3,000 providers in one state or one MCO line of business.
  2. Post-payment analysisYou send anonymized claims metadata: tokenized TIN, claim amount, date of service, place-of-service code, billed CPT/HCPCS. No member data.
  3. Anonymize their dataProvider tokens replace real TINs. Member identifiers are out of scope. JIL never sees a name. Limited BAA executes in days, not months.
  4. Show proof Tier 1 is correctWe deliver a verdict per provider with public-data citations. Your SIU verifies against internal intelligence. You sign off on T1 detection accuracy before any T2 spend.
Tier 1 is the trust-building moment - you validate before you escalate06 / 10
Production Pricing · v4.1

Annual covers detection.
CREB fee covers proof.
Half of CREB is recovery-tied.

LayerPricingWhat's included
Annual subscription$500K - $2M annual
tier-dependent		Continuous 2-week / 4-year retroactive sweep across approvals and denials. Sub-floor reports (<$250K recoverable) included. Best-effort review SLA on Standard tier; dedicated review queue + named CSM on Enterprise tier.
Above-floor CREB®15% of recoverable
7.5% at seal + 7.5% at recovery		Court Ready Evidence Bundle for any cluster above the $250K configurable floor. FRE 902(13)-eligible, cryptographically signed and court-anchored. Half the fee triggers only when you collect.
Enterprise block commit$300K - $4M+
100 - 2,500+ reports / yr		For UHG-tier customers: predictable annual block of sub-floor reports with dedicated review queue, faster turnaround, and procurement-friendly single-PO commercial structure. Block ladder defined per customer.

All parameters (floor, rate, tranche split, block size) are per-customer configurable. Net-30 invoicing. Master agreement plus limited BAA in 5-10 business days. POC structure available for first 90 days: $250K typical Tier 1 + per-case Tier 2/3.

15% above floor · sub-floor included in annual · half tied to recovery07 / 10
Rollout Path

Crawl. Walk. Run.

30 / 90 / 180 days. Each phase has a defined exit gate so you can stop anywhere without sunk cost.

Crawl
Day 1 - 30
Tier 1 POC
One high-risk cohort. Validate findings against your SIU benchmarks. Sign off on detection accuracy before any escalation. Exit gate: T1 verdict pack delivered.
Walk
Day 31 - 90
Tier 2 substantiation
Top 20-50 cases get Tier 2. First CREB® deliveries. Workflow handoff to your AP, refund, and SIU teams. Exit gate: first refund processed.
Run
Day 91 - 180
Production cadence
Quarterly Tier 1 sweeps across your full Medicaid book. Tier 2 on demand. Safe-harbor refund pipeline live with the 60-Day Rule built in.
Each phase is independently terminable - no enterprise lock-in08 / 10
The Math

What you save vs. what it costs to wait.

Detection uplift
+30-50%
Over rules-based engines, measured across 23 verticals where JIL has live POCs. Public-data signals catch what claims-data alone cannot see.
FCA exposure avoided
$33K - $66K
Per missed claim once it goes past the 60-day clock. Base $11K-$22K trebled, plus 15-30% qui tam relator share if a relator files first.
Qui tam premium
$5M - $15M
Per provider exposure once a relator files. Cooperation credit available only BEFORE the qui tam. Self-disclosure is the only durable defense.
Opportunity cost of doing nothing: every additional 60-day cycle without integrated post-payment integrity is a separate FCA exposure window. POC pays for itself on case #1.
Opportunity-cost math - validated against published settlements09 / 10
Next 30 Days

We can be on a discovery call in 5 business days.

Five things to send to start kickoff:

  1. Cohort definitionGeography, claims window, provider type, dollar threshold. Any one MCO line of business.
  2. Anonymization schemeTokenized TIN. No member data. We will share our reference scheme as a starting point.
  3. Internal SIU benchmarkSo we can measure detection uplift against what your team already finds today.
  4. Decision authorityCFO + CCO + general counsel for the POC purchase order. Director or VP signoff threshold for the limited BAA.
  5. Target Tier 1 deliverable dateTypical T1 turnaround is 21-30 days from cohort handoff.
Schedule a discovery call Email bizdev directly
jilsovereign.com · bizdev@jilsovereign.com · JIL-MCO-INTRO-2026.0510 / 10
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In plain English

What this brief is for.

If you're an MCO Chief Compliance Officer, an SIU director, or a Medicaid health-plan executive, this is the short answer for the regulatory situation we're addressing. The full brief sits below.

Why the 60-day clock matters

CMS / HHS-OIG audit posture in 2026 has tightened the post-audit response window. The 60-day clock is the timeline between audit notice and the moment your plan owes a corrective-action plan or a financial response. Underprepared plans lose multi-year recoupment fights they should have won.

What JIL provides

Pre-built CREB® evidence packages covering FWA detection methodology, claim-level audit defensibility, and per-finding remediation. Walk into an audit with a signed evidence package per challenged claim cluster, not a binder of unsigned screenshots.

Where this fits in your existing program

JIL doesn't replace your in-house SIU or your existing FWA vendor. It adds the cryptographic evidence + audit-ready packaging on top. Plans typically run JIL alongside their existing FWA stack for the first 6-12 months.

What to do this week

Schedule a call (link below) for a 30-minute walkthrough of the audit-ready package. We'll show real CMS public-data findings + the CREB® format your auditor will see. No PHI required.

Slide 06 · PHI handling and HIPAA posture

We don't need your PHI to find your fraud.

By architecture, not by promise.

Tier 1 detection runs on hashed identifiers and analytic features. JIL never sees a member name. Pre-Settlement Attestation, Retroactive Tier 1 with Ava, and Wallet Intelligence operate as a HIPAA Limited Dataset receiver under §164.514(e) or under Safe Harbor de-identification per §164.514(b)(2). PHI enters the workflow only when you authorize a Tier 2 or Tier 3 case escalation, and even then it runs in an isolated enclave that does not co-mingle with the Tier 1 production path.

Product Non-PHI PII PHI / ePHI BAA scope
Pre-Settlement Attestation Counterparty, beneficiary, bank fingerprint No PHI Limited
Retroactive Tier 1 (Ava) Hashed claim IDs, NPIs, TINs, amounts No PHI Limited
Retroactive Tier 2 (case investigation) Yes PHI · Case-level Full
Retroactive Tier 3 (CREB® hand-engaged) Yes PHI · Full case file Full
Wallet Intelligence Limited No PHI Not required
Limited BAA · Tier 1

Executes in days.

Counsel review is narrow. No PHI in scope.

Covers Pre-Settlement, Retroactive Tier 1, Wallet Intelligence. Buyer holds the re-identification key. JIL never sees a name. A breach on the JIL side cannot expose your members. Director or VP signoff threshold.

Full BAA · Tier 2/3

Stages on Tier 1 sign.

Activates on first authorized case escalation.

Covers Tier 2 case investigation and Tier 3 CREB® hand-engaged work. PHI runs in an isolated enclave with field-level audit log under §164.312(b), per-case access provisioning, and the §164.410 60-day breach notification ceiling. CPO, CCO, or General Counsel signoff.

Subprocessor disclosure · Agentic AI compute

Amazon Web Services, Inc. · the AI cloud beneath Ava.

JIL hosts agentic AI workloads on AWS (Bedrock + SageMaker). AWS Bedrock + SageMaker maintains SOC 2 Type II and ISO 27001 alignment, operates a published Shared Responsibility Model, signs a HIPAA Business Associate Agreement on request, and has a publicly disclosed HITRUST CSF program in flight.

By tier: Ava on AWS Bedrock + SageMaker is a no-PHI path. Tier 1 inference logs, embedding stores, and prompt-context windows do not contain PHI by architecture (the hashes never decrypt). Tier 2/3 PHI does not leave JIL's enclave; where AI assistance is needed, requests route through a controlled gateway with PHI redaction or tokenization before any external inference call.

Read the full attestation Sample MSA & DPA with BAA Download MCO Customer Deck (PDF) Request the BAA register Doc · JIL-HIPAA-2026.05 · v1.0
Schedule a discovery call Full 20-slide technical deck Public-Data POC ($1.18B in DRG cohort overage) Live Ava demo Email bizdev directly
Confidential, institutional distribution. This brief is intended for managed-care organizations, Medicare Advantage organizations, Medicaid agencies, and Part D plan sponsors. JIL is the documentation layer that makes self-disclosure defensible. JIL is detection, proof, and attestation - not recovery.