MAC + UPIC + state Medicaid

DMEPOS Fraud Detection

DMEPOS 2024 case study delivered 26 to 87x ROI on Tier 2 spend. Face-to-face encounter validation, supplier relationship conflict detection, competitive bidding contract compliance.

The DMEPOS fraud landscape

The DMEPOS fraud landscape is a subset of CMS $30B priority lanes, presenting a significant challenge for MAC, UPIC, and state Medicaid programs. Fraud in this sector often involves complex schemes that require sophisticated detection methods to uncover.

JIL Sovereign's expansion into DMEPOS fraud detection addresses these challenges head-on, offering a comprehensive solution that leverages public data and commercial subscriptions to deliver high-value insights.

With 16 new attestation checks specifically designed for DMEPOS fraud, JIL Sovereign enhances the detection capabilities of existing verticals, ensuring that buyers can effectively combat fraud in this critical area.

How JIL closes it

JIL Sovereign closes the DMEPOS fraud gap through a combination of face-to-face encounter validation, supplier relationship conflict detection, and competitive bidding contract compliance checks.

By integrating these checks into the existing platform, JIL Sovereign ensures that buyers have access to a robust set of tools that can be deployed quickly and effectively.

The integration of new verticals and primitives into the JIL platform is seamless, leveraging the existing architecture to deliver new capabilities without the need for platform rebuilds.

DMEPOS 2024 case study

The DMEPOS 2024 case study delivered a remarkable 26 to 87x ROI on Tier 2 spend, demonstrating the effectiveness of JIL Sovereign's solution in detecting and preventing fraud.

This case study highlights the impact of JIL Sovereign's attestation checks, which include face-to-face encounter validation, supplier relationship conflict detection, and competitive bidding contract compliance.

The success of the DMEPOS 2024 case study underscores the value proposition of JIL Sovereign's solution for MAC, UPIC, and state Medicaid programs.

Pricing

JIL Sovereign offers flexible pricing options to accommodate the diverse needs of its buyers.

Pricing -- Fraud Pillar Standard

One model. Bottom-line aligned.

Retroactive scan

one-time, scoped to volume

4-year minimum lookback. Builds the base dataset. Proves the closed-loop economics before the flat-fee leg starts.

Flat fee

12.5% of disclosed PI spend

Annual, capped. Covers nightly T1 + AVA + T2 + CREB(TM) generation. Below the industry-standard 15 to 25% SIU contingency.

Contingency

10% of net cash recovered

Performance-aligned. Fires only on actual recovered cash, net of MAC appeal, settlement, and pursuit. Outside counsel runs 33%.

90-day pilot

$1M all-in, asymmetric downside

If Day 90 deliverables miss, the $1M converts to a 6-month platform credit and contingency drops from 10% to 7.5%. No other vendor in PI takes pure downside on the math.

90-day pilot

JIL Sovereign invites buyers to participate in a 90-day pilot program to experience the benefits of its DMEPOS fraud detection solution firsthand.

During the pilot, buyers will have access to the full suite of attestation checks and CREB bundles, allowing them to evaluate the solution's effectiveness in their specific context.

The 90-day pilot is an opportunity for buyers to see the tangible results of JIL Sovereign's solution and make an informed decision about their fraud detection strategy.