MCO Payment Integrity · Live Walkthrough · 30 seconds
Watch one engagement run end to end.
Press play and watch a Managed Care Organization payment-integrity engagement execute step-by-step - CMS data ingest, Tier 1 detection, AVA clustering, Tier 2 substantiation, CREB seal. All numbers come from the live eng-mco-dmepos-2024-showcase engagement running right now on customer.jilsovereign.com.
Player
Six stages, thirty seconds.
Each stage shows the work happening + the numbers that tie out at the end. Stop, replay, or click through to the live customer view at any point.
Data ingestion - CMS public data + LEIE + NPPES
JIL pulls authoritative public sources from its Snowflake mirror. No PHI. Customer data never leaves the customer perimeter at any stage.
- NPPES providers indexed
- 9,401,238
- OIG LEIE exclusions
- 67,432
- Medicare Part-B claims (FY22-24)
- 145,827,310
- CMS Provider-of-Services rows
- 44,217
- USPS CMRA premise registry
- 241,604
- SAM.gov exclusions v4
- 167,456
Tier 1 detection - 175 deterministic checks fire in parallel
Every check is statutorily-cited, versioned, audit-traceable. T1 is the screening signal layer - high recall, no contingency on findings reaching the customer report.
- Checks executed
- 175
- Findings generated
- 1,847
- Top fault codes firing
- DME-001 · LEIE-001 · PREM-001 · REC-001
- Statutory authorities cited
- 31 USC 3729 · 42 CFR 414.230 · 42 USC 1320a-7
- Runtime on Snowflake compute
- 3.2s wall · 0 warehouse rows materialized customer-side
AVA clustering - 1,847 findings grouped into 4 case clusters
AVA groups the raw findings by entity + fraud archetype + time window. Each cluster carries economic exposure, recovery estimate, FCA path, and a recommendation. Cluster construction is deterministic - same inputs, same clusters, every time.
AVA recommendation - per-cluster verdict + statutory path
AVA scores defensibility (statutory binary, observable evidence, judicial precedent), not gross dollars. Each verdict comes with the False Claims Act pathway, recovery band, and CREB readiness.
- Cluster 01 verdict
- ESCALATE · FCA § 3729 · per-claim penalty applies
- Cluster 02 verdict
- ESCALATE · 42 USC 1320a-7 statutory binary
- Cluster 03 verdict
- ESCALATE · 42 CFR 424.516 enrollment
- Cluster 04 verdict
- ESCALATE · FCA pattern + recidivism
- Total escalated
- 4 of 4 clusters · $100.00M exposure
Tier 2 substantiation - paid vendor evidence pulls in parallel
Tier 2 is where the vendor proves legitimacy to the MCO. No T1 flag becomes a finding in the customer report until at least one T2 source corroborates it. This is the no-false-positives guarantee.
- Cases substantiated
- 132 of 132
- False positives reaching report
- 0
- Total T2 cost (vendor + ops)
- $168K · bundled in annual run fee
CREB seal - FRE 902(13) self-authenticating, 14-of-20 BFT signed
The Court Ready Evidence Bundle packages findings + statutory citations + chain-of-custody + cryptographic seal. Anchored to JIL L1 (14-of-20 BFT validators across 13 jurisdictions). The CREB fee at full approval is JIL's revenue - 10% of cluster exposure, $250K floor per bundle.
- Merkle root
- 0x8a13f...c93e2
- Validator signatures
- 14 of 20 · US, DE, CH, JP, SG, GB, AE, BR, ...
- CourtChain anchor
- L1 block 14,289,317 · finality < 6s
- Self-authenticating under
- FRE 902(13) · admissible without custodian testimony
- CREB fee at full approval
- $10.00M · 10% × $100M, $250K floor / bundle
Money story
Ten seconds of compute, $100M of exposure surfaced.
total exposure across 4 clusters · 132 cases substantiated · pursuing yields ~10× on the CREB fee at the low band.
| Cluster | Cases | Exposure | CREB fee (10%) | Recovery (low - high) | AVA |
|---|---|---|---|---|---|
| DMEPOS upcoding v2 | 38 | $30.00M | $3.00M | $30M - $90M | ESCALATE |
| LEIE-excluded provider | 33 | $25.00M | $2.50M | $25M - $75M | ESCALATE |
| Phantom premise | 28 | $20.00M | $2.00M | $20M - $60M | ESCALATE |
| Multi-year recidivism | 33 | $25.00M | $2.50M | $25M - $75M | ESCALATE |
Customer pays the $10M CREB fee at full approval · recovers $100M-$300M through MAC overpayment process or FCA litigation · nets $90M-$290M after JIL's fee. Compared to the customer's real alternative (outside counsel + forensic accountants typically charge 25-33% of recoveries), JIL at 10% is roughly one-third the cost and faster.
Run it in your terminal
Same walkthrough, Linux CLI version.
Same six stages, same numbers, same animation - in your terminal in 30 seconds. Zero dependencies beyond Bash and coreutils. Useful when you want to walk a customer through the flow on a Zoom screen-share without leaving the terminal.
Flags: --fast skips per-line animation (full reveal in 6s) · --no-color for log piping · --json emits NDJSON for downstream pipelines.
Source mirror lives in the repo at scripts/demo/mco-walkthrough.sh. Inspect before piping; the script is short, audited, and signed off as safe-to-curl.
See it live
Want to scroll through the actual sealed engagement?
The showcase engagement runs right now in our customer workspace. All numbers above tie out across every tab - Live Overview, AI Triage (AVA), Paid Investigation (T2), AI Escalation (AVA Pro), Court-Ready Evidence (T3), Ongoing Monitoring (AVA Pro+).
Open showcase live -> Schedule POC on your own data