For State Agencies & Legislatures

Sentinel is purpose-built for state agencies and legislative oversight bodies nationwide — across Medicaid, SNAP, child welfare, workforce, housing, and every funded program. We draft the proviso language. We define the data standard. We deliver the results.

The Proviso Model

How Sentinel gets funded — and why it works

Funding Through Legislation

Sentinel is typically funded through legislative proviso rather than traditional RFP-based contracting. This means:

  • Legislators define fraud prevention goals in bill language
  • We are named or selected through proviso process
  • Funding comes from existing program appropriations
  • No new budget request required
  • Quarterly reporting to legislative committees
  • Results measured against legislatively-defined metrics

Why This Structure Works

The proviso model aligns incentives perfectly:

  • Legislature gets direct oversight of program integrity spending
  • Agencies get intelligence infrastructure without additional appropriation
  • Sentinel has clear accountability to elected leadership
  • No multi-year contract lock-in — annual review and renewal
  • Fast deployment (2 weeks from contract signature)
  • Flexible scope and metrics definition

We can draft your proviso language. Contact David to discuss how to structure legislation that accomplishes your state's program integrity goals across any funded agency.

Minimum Data Reporting Standard (MDRS)

What data Sentinel needs to deliver results — applicable across any state-funded program

Three Core Data Elements

Claims Data

  • All paid and denied claims/payments (837, EBT, case mgmt, or equivalent)
  • Service/benefit date, provider/vendor, code, amount
  • Beneficiary/recipient ID and eligibility status
  • Prior authorization and case action information
  • Frequency: Weekly incremental updates

Eligibility Data

  • Current beneficiary/recipient enrollment status
  • Income, household composition, and eligibility factors
  • Enrollment source (initial, renewal, referral, etc.)
  • Program type, coverage category, and benefit level
  • Frequency: Monthly full refresh

Provider & Policy Data

  • Active provider/vendor enrollment and credentials
  • Fee schedules, rate tables, and payment methodologies
  • Contractor and MCO contracts where applicable
  • Program policy documents, rules, and administrative guidance
  • Frequency: Monthly updates + notification of changes

Data Security & Compliance

Pricing & Service Tiers

Per-agency pricing based on program size and complexity

Tier 1: Base
$180K
Annual
  • Single-program claims/payment analysis
  • Weekly fraud detection reports
  • Basic dashboard and reporting
  • Up to 5 designated users
  • Email support
Tier 3: Enterprise
$850K
Annual
  • Full suite all features
  • Cross-agency correlation and analysis
  • Custom fraud vector development
  • Multi-state analysis and correlation
  • Unlimited users
  • Dedicated account management

Pricing includes 24/7 monitoring, weekly reports, quarterly briefings, and all dashboard access. No setup fees. No per-claim charges. Proviso-funded model available for annual renewal.

Measurable Outcomes

What states should expect from Sentinel deployment

Fraud Reduction

15-25%

Verified reduction in improper payments through real-time detection and prevention of fraud before payment. Measured against pre-Sentinel baseline.

Waste Reduction

10-20%

Prevention of waste through fee schedule corrections, denial management, and claims optimization. Accumulated across all detection vectors.

ROI

5x-8x

For every $1 spent on Sentinel oversight, states recover or prevent $5-$8 in fraud, waste, and improper payments.

Detection Speed

30 Days

From contract signature to live fraud detection. No lengthy system integrations or lengthy implementations. We're monitoring on day 2.

Compliance & Regulatory Framework

Sentinel is built for the regulatory environment state agencies operate in

HIPAA Compliance

  • Business Associate Agreement signed
  • AES-256 encryption in transit and at rest
  • Audit logs and access controls
  • Data retention policies aligned to state requirements

CMS Program Integrity Requirements

  • 42 CFR Part 431 compliance
  • CMS Program Integrity guidance adherence
  • OIG coordination and reporting
  • Federal audit trail standards

State Legislative Oversight

  • Quarterly reporting to legislative committees
  • Proviso compliance tracking and documentation
  • Budget variance analysis and explanation
  • Open records requests support

Audit Readiness

  • Complete documentation chain for every finding
  • Regulatory violation mapping (CMS, OIG, state)
  • Evidence preservation and validation
  • Audit trail and change logs

Implementation & Timeline

Fast deployment, no disruption to existing systems

Week 1

Contract & Data Onboarding

Sign contract. Receive secure SFTP credentials and data upload instructions. Your data team uploads claims, eligibility, and provider files via secure file transfer.

Week 2

Initial Analysis & Kickoff

Sentinel completes initial analysis on uploaded data. Fraud vectors are calibrated to your state's programs and policies. Kickoff call with agency leadership and David Thorne.

Week 3+

Live Monitoring & Reporting

Weekly fraud detection reports. Real-time dashboard access. Monthly calls with agency leadership. Quarterly legislative briefings. Continuous monitoring of new claims and policy changes.

Ready to Deploy Program Integrity Intelligence?

Sentinel is ready to serve your state. We can draft proviso language, define your MDRS data standard, and have you monitoring fraud within 2 weeks of contract signature. Schedule a conversation with David to discuss your state's program integrity goals.

Schedule a Government Demo