Federal Programs
Medicare Program Integrity Solutions
Scaling federal reviewer capacity to support the CMS 14:1 ROI mandate — without proportional FTE growth.
No automated coverage decisions. No unsupervised denials. All outputs are strictly advisory. Every determination is linked to an immutable source citation. Clinical judgment remains with the human reviewer. Full audit trail on every finding.
Core Capabilities
Demonstrated across Medicare's highest-burden review workflows — available for deployment
Hospice Certification Validation
Cross-references face-to-face certification narratives against the clinical record in under 2 minutes. Flags incongruence with exact paragraph linking. Designed to support CPI's oversight expansion without proportional FTE increases.
Example finding
A certification claiming oxygen dependence — when the clinical note documents normal O₂ saturation and independent daily activity — is flagged automatically, with the source paragraph cited.
RADV Encounter Review
Distinguishes active clinical management from historical problem list mentions. Structures source-cited evidence to expand reviewer throughput and strengthen the CMS position in provider appeals.
Example finding
A condition appearing only in the problem list — without corresponding assessment, treatment, or monitoring in the encounter note — is identified as insufficient support for the submitted diagnosis code.
LCD/NCD Criteria Mapping
Supports medical necessity reviews for high-risk categories including DMEPOS, skin substitutes, and MoIDX. Shifts workflows from pay-and-chase to pre-payment prevention.
Example finding
Documentation is automatically mapped against each LCD criterion with a clear Met / Not Met / Missing determination and direct source citation — ready for reviewer sign-off.
Scale
Federal reviewer capacity scaled by an order of magnitude — without adding headcount. Every finding carries an immutable source citation for the audit trail.
Evidence extraction for program integrity · RADV encounter review · LCD/NCD criteria mapping · Hospice certification validation
Deployment
Frictionless integration into existing federal infrastructure
UPIC / MAC Integration
Designed for integration into incumbent UPIC and MAC secure enclaves via FHIR API. Processing runs on HIPAA-compliant AWS infrastructure — PHI de-identified before inference, no outbound calls to external AI providers.
- AWS GovCloud compatible — dedicated infrastructure options available by contracting
- Internally authorized AWS Bedrock endpoints
- FHIR R4 API — no proprietary connectors
- CMS ARS 5.1 control alignment
Procurement Vehicles
Available for teaming arrangements with prime contractors on CMS and OIG vehicles. SAM.gov registered · Small Disadvantaged Business (SDB), self-certified. Contact us for deployment architecture documentation and teaming discussions.
- SAM.gov Active · NAICS 541512
- Small Disadvantaged Business (SDB) · SAM.gov Self-Certified
- Open to teaming with prime contractors
- Deployment documentation available on request
Request a federal technical briefing
We welcome briefings with CMS, OIG, UPIC contractors, and MAC prime contractors. Deployment documentation and teaming discussions available on request.