PROGRAM INTEGRITY & RISK ADJUSTMENT

SME-driven modeling, audit support, and oversight analytics

HEALTH IT & DATA ENGINEERING

Trusted to modernize pipelines,
platforms, and program data

AI-ENHANCED OVERSIGHT & GenAI TOOLS

AI tools deployed to support audits,
policy, and regulatory oversight

Exceptional & Reliable Partner

Supporting CMS and other healthcare agencies with expertise in Risk Adjustment, Quality of Care, Encounter Data, Prescription Drug Data, Fee-for-Service Claims, MAC program, Physician Fee Schedule, and Program Integrity

Program Integrity & Risk Adjustment

Risk adjustment model design, evaluation, and implementation for part C, Part D, ACO and VBC
Integrated FFS, Part C, Part D and Medicaid data analytics for program management and fraud, waste, and abuse detection
Expertise in Encounter data ingestion, validation, and analytic use in payment and oversight
Support for CMS CPI audits, RADV, payment error analysis, and chart validation
Development of AI/ML tools for anomaly detection and improper payment risk scoring
Regulatory policy analysis and modeling support aligned with CMS innovation initiatives

Snowflake data warehouse environment architecture and data model optimization
Scalable data pipelines using AWS-native services (Glue, S3, Lambda)
ETL/ELT workflows supporting real-time and batch processing
Infrastructure-as-Code (IaC), CI/CD, and DevOps for analytics platforms
Support for CMS operations through sustained infrastructure, data refresh cycles, and platform reliability monitoring
Develop secure front-end platforms for data submission, performance tracking, and CMS oversight
Technical modernization of legacy tools and platforms (e.g., SAS® to Python/SQL migrations)

Health IT & Data Engineering

AI-Enhanced Oversight & GenAI Tools

Deploy RAG and GenAI tools to support regulatory research, audit prep, and documentation review
Build AI agents to autonomously retrieve data, generate rules, and assist with guidance development
Apply NLP and ML for fraud detection, forecasting, and risk model evaluation
Deliver explainable dashboards and self-service tools powered by AI pipelines
Leverage GenAI to support code review, SAS-to-Python/SQL conversion, and documentation

Magpie Health Analytics is a mission-focused small business supporting CMS, HHS-OIG, and their partners with data-driven oversight, policy-aligned analytics, and modern infrastructure. With deep expertise in Medicare program integrity, encounter data, risk adjustment, and AI-enhanced tools, Magpie enables federal agencies to improve payment accuracy, reduce fraud, and modernize legacy systems. We are a trusted subcontractor on CMS and HHS contracts and hold a GSA MAS Schedule. Our team includes former government analysts, policy experts, and cloud engineers working together to deliver full-spectrum solutions — from risk adjustment modeling to secure front-end platforms for federal oversight.

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Teaming Inquiries, RFPs, or Technical Questions?

Reach out to:

support@magpiehealthanalytics.com

✔ GSA MAS Schedule #47QRAA19D005A

✔ SBA-registered small business (UEI: W2K3RZV65MW3)

Mission-Critical Data & Oversight
for CMS and HHS