Stop Paying the Wrong Providers. Start Proving You Did Not.
You do not have a detection problem. You have an architecture problem. Medicare and Medicaid programs pay first and audit later - and the audit almost never catches up. JIL moves the verification gate to before the payment leaves.
CMS-reported improper payments across Medicare, Medicaid, CHIP, and the ACA exchange in FY2024 - the eighth consecutive year above threshold.
The problem in one paragraph
79% of Medicaid improper payments in FY2024 were caused by missing or insufficient documentation - not sophisticated fraud. The payment cleared because the documentation gate does not exist before settlement. The provider submitted a claim. Nobody confirmed they were enrolled, licensed, and operating at a real address on that date. The money moved. The audit found the problem months later. Recovery averaged pennies on the dollar. The same GAO finding has come back for eight consecutive years with no structural fix in the current architecture.
Five questions your current system does not ask.
Before any provider payment is released, JIL answers:
- Is this provider enrolled and in good standing on this exact date?
- Does the documentation for this claim actually exist and match what was billed?
- Is the billed amount consistent with what this provider type, procedure code, and service area normally produces?
- Has this claim - or one close to it - already been paid anywhere else?
- Is the provider billing from a location that could physically deliver these services?
If any answer is no, the payment holds. The analyst sees the reason. The money does not move until it should.
Seven checks. Targeted to your exposure.
You do not pay for checks that do not apply to your payment type. For Medicare and Medicaid disbursements, the relevant checks are:
- Provider NPI and PECOS enrollment - active status verified on the payment date, not just at contracting
- OIG exclusion screening - date-anchored, not a current-only lookup
- License status - active, expired, or revoked on the exact date of service
- Duplicate claims detection - across payers, not just within your own system
- Billing corridor analysis - upcoding and unbundling detection against procedure code norms for this provider class
- Address and service area plausibility - physical capability to deliver the billed service from where they operate
- Documentation completeness - claim is bound to supporting evidence before a Yes verdict is issued
7 CHECKS. TARGETED TO YOUR EXPOSURE. NOTHING IRRELEVANT RUNNING AGAINST YOUR PAYMENTS.
Look backward. Reconstruct compliance status on every date.
If you need to look backward, JIL runs the same verification against your entire payment history. Every provider. Every claim. Every date. The system reconstructs the provider's exact compliance status on the date each payment was made - not what it is today.
100 million records in 10 to 20 minutes. Post-quantum cryptographically sealed findings. Suitable for HHS OIG referral, CMS ZPIC intake, and False Claims Act proceedings. JIL builds the case file. You do not reconstruct it manually.
Quantified recovery. Forward prevention. Operational leverage.
Direct Financial Recovery
- Example: 50M claims per year x 4-year lookback = 200M historical records
- Investigation Engine run: starting at 5 bps per record = ~$1M - $2M cost
- FWEA findings at 3% exposure on $10B annual disbursement = ~$300M identified
- Typical recovery at 30 - 50% of findings = $90M - $150M recoverable
- ROI on investigation spend: 45 - 150x
- Revenue-share option available: 10% of confirmed recovered funds, zero upfront cost
Forward-Looking Prevention (per $1B annual disbursement)
- 1% improper payment reduction = $10M annually prevented
- 0.5% reduction = $5M annually prevented
- 0.1% reduction = $1M annually prevented
- JIL engagement cost on $1B volume at 35 bps = ~$3.5M annually
- Net benefit at 1% prevention: $6.5M year one, growing with volume
Operational Benefits
- Audit reconstruction time eliminated - every verdict is already sealed and retrievable via API
- Recovery Auditor Contractor spend reduced - fraud prevented before payment is faster and cheaper than clawback after
- GAO compliance evidence generated automatically at payment time, not reconstructed retrospectively
- Analyst review queue focused only on REVIEW verdicts - not every claim - significantly reducing SIU workload
Risk and Compliance Benefits
- Date-anchored cryptographic proof satisfies DOJ Civil, HHS OIG, and False Claims Act evidentiary requirements
- Every NO verdict is documented with the specific reason - defensible in any regulatory proceeding
- Cross-payer duplicate detection unavailable in any current single-payer system - unique to JIL's shared attestation ledger
3 to 5 weeks for most healthcare payer engagements.
JIL runs alongside your existing claims system. No migration. No disruption to current payment operations. You see what your current controls miss before committing to full deployment.
Request an Investigation Engagement
See JIL attestation infrastructure applied to your healthcare payer or CMS program corridor. Revenue-share available - zero upfront cost on retroactive engagements.
or email support@jilsovereign.com