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.
Here's what we catch for you before the claim payment releases.
If you run program integrity, fraud investigation, or claims operations at CMS, a state Medicaid agency, a managed care organization (MCO), or a Medicare Administrative Contractor (MAC), this is what JIL screens before each provider claim disbursement clears. JIL plugs in between your claim adjudication system and your payment-release function and produces a verdict per claim in seconds. Your fraud unit gets a clear queue; auditors get sealed evidence per decision.
Provider billing for services not rendered
Provider bills 18 hours a day of patient encounters per single rendering provider. Or claims procedure codes that are statistically inconsistent with their documented diagnosis pattern. Or bills for telehealth visits that overlap with their other in-person appointments at the same clock time. JIL surfaces the impossibility before the disbursement.
Phantom provider (NPI with no real practice)
NPI is registered, but the practice address is a UPS Store box. The provider has no commercial-utility records, no real-estate footprint, no licensure-board record, and no prior payer-claim history at this address. JIL surfaces the phantom-provider pattern with the verification data your investigator can act on.
OIG-excluded provider re-emerging under a new tax ID
Provider was OIG-excluded in 2022. Now there's a new tax ID, new entity name, new NPI - but the same physical address, same beneficial owner, same bank fingerprint. JIL catches the re-activation pattern before the first disbursement.
Multi-state UBO ring
Same beneficial owner appearing across 13 states under different LLCs, with different state Medicaid IDs, all billing similar service patterns. JIL surfaces the network with the entity graph and the dollar exposure.
Premise-business mismatch
Medical billing from a residential address. Therapy practice on a daycare premise. Lab work from a mailbox-store address. DME (durable medical equipment) provider operating from a strip mall billing for 47 wheelchairs/month. JIL surfaces the premise pattern with the supporting evidence (commercial real estate records, business-registration records, photographic where available).
Sealed evidence per blocked or held claim
Every claim JIL holds gets a sealed evidence record showing exactly why - the impossibility, the network pattern, the OIG match, the address mismatch. Useful for fraud investigation, MAC referral, OIG referral, qui tam relator support, and FCA proceedings. Court-admissible without an expert witness.
A clear / hold / fail verdict per claim, with sealed evidence.
For every claim disbursement your system asks JIL about, you get back: a verdict at sub-second latency, a sealed evidence bundle (CREB™ - Court-Ready Evidence Bundle) showing every check that ran and which sources were consulted (NPPES, OIG LEIE, SAM.gov, CMS PECOS, state Medicaid registries, etc.), and a cryptographic signature that proves the verdict hasn't been altered. Cleared claims release immediately. Holds go to your existing fraud-investigation queue. The bundle is admissible in MAC appeals, OIG investigation, qui tam proceedings, and FCA litigation without an expert witness.
Plug in between adjudication and payment release.
1 · Your claims system calls JIL
Standard REST integration. JIL sits between your adjudication output and your payment-release function. No change to the adjuster or fraud-investigator workflow.
2 · Verdict in seconds
JIL runs NPPES + OIG LEIE + SAM.gov + CMS PECOS + entity-graph + UBO + premise-mismatch + impossibility checks in parallel. Verdict + sealed evidence returned synchronously.
3 · Holds go to your fraud queue
Cleared claims release immediately. Holds go to your existing investigation queue with structured evidence. CMS 60-Day Rule compliance documented per claim.
Cents per claim. ROI in basis points of program loss.
JIL Medicare/Medicaid Provider Payment screening is priced per-claim, with steep volume discounts for CMS / state-Medicaid / MCO scale. CMS reports $87.1B in improper payments annually. Even a 1% reduction in a single MCO's improper payment exposure typically returns 100x or more on the JIL spend. Fixed-fee per scan, not contingency - the program's recovery savings stay with the program. Aligns with the CMS 60-Day Rule and FCA cooperation-credit framework.
$87.1 billion in improper payments. Eighth consecutive year above threshold.
CMS-reported improper payments across Medicare, Medicaid, CHIP, and the ACA exchange in FY2024 - the eighth consecutive year above threshold.
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:
Active enrollment status verified on the payment date, not just at contracting.
Date-anchored, not a current-only lookup.
Active, expired, or revoked on the exact date of service.
Across payers, not just within your own system.
Upcoding and unbundling detection against procedure code norms for this provider class.
Physical capability to deliver the billed service from where they operate.
Claim is bound to supporting evidence before a Yes verdict is issued.
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.
- Example: 50M claims per year x 4-year lookback = 200M historical records.
- Investigation Engine run: starting at 5 bps per record = ~$1M to $2M cost.
- FWEA findings at 3% exposure on $10B annual disbursement = ~$300M identified.
- Typical recovery at 30 to 50% of findings = $90M to $150M recoverable.
- ROI on investigation spend: 45 to 150x.
- Revenue-share option available: 10% of confirmed recovered funds, zero upfront cost.
- 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.
- 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.
- 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.
Built to operate. Not demonstrated in a lab.
JIL Sovereign's reference mainnet runs in production today across ten SCN validator jurisdictions on three continents.
Pay-and-chase has been the operating posture for forty years. JIL inverts the architecture. Verify before settlement. Audit becomes a query, not a project. JIL Sovereign - Healthcare corridor thesis
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.
Request a briefing
One mailbox for healthcare payer briefings, MCO integrity intake, and CMS program scoping. Response within one business day.
Schedule a call
For confidential institutional inquiries. Routed to the partner desk for healthcare corridor scoping and Investigation Engine engagements.