MACs + UPIC + MEDIC + DOJ HC Fraud Unit

Telehealth, DME, and Hospice Fraud Detection

Lane-specific repackaging of JIL's Medicare data spine to address the four CMS-signaled priority lanes. $30 billion federal exposure.

The 4 lanes

Addressing the Four CMS Priority Lanes

JIL Sovereign's lane-specific repackaging of the Medicare data spine addresses the four CMS-signaled priority lanes: Telehealth, Durable Medical Equipment (DME), Hospice, and Genetic Testing. These lanes represent a $30B federal exposure.

How JIL closes them

22 Attestation Checks Across the Four Lanes

JIL Sovereign employs 22 specialized attestation checks to close the integrity gaps in the four priority lanes. These checks are designed to detect anomalies, discrepancies, and potential fraud across the specified areas.

Lane-specific CREB templates

Court-Ready Evidence Bundles (CREB) for Each Lane

Each priority lane has a dedicated CREB template that ensures the evidence bundles are tailored to the specific requirements and evidentiary standards of that lane.

Anti-Kickback + Stark + FCA

Compliance with Anti-Kickback, Stark, and False Claims Act (FCA)

JIL Sovereign's solutions are designed to ensure compliance with the Anti-Kickback Statute, Stark Law, and the False Claims Act, providing buyers with confidence in their integrity programs.

Pricing

Transparent and Competitive Pricing

JIL Sovereign offers transparent and competitive pricing models, including a 12.5%+10%+4yr structure, to fit the budgetary constraints and needs of institutional 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.

Pricing anchored to public 10-K Schedule H disclosures + CMS PERM 2024. UHG-scale case study available at /products/mco-flat-fee.

90-day pilot

90-Day Pilot Program

Buyers can engage in a 90-day pilot program to experience the efficacy and value of JIL Sovereign's solutions before committing to a full deployment.