Mission-Critical Data & Oversight for CMS and HHS

Magpie supports program integrity, risk adjustment, and modernization through policy expertise, cloud-native systems, and AI tools that help CMS and HHS improve accuracy, reduce fraud, and strengthen oversight.

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

Capabilities Statement

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

Get Help with your Infrastructure

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

Our Company

Government Health Offerings

Analytics to help achieve your healthcare program goals

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.

Contact

Teaming Inquiries, RFPs, or Technical Questions?

Reach out to:
support@magpiehealthanalytics.com

✔ GSA MAS Schedule #47QRAA19D005A
✔ SBA-registered small business (UEI: W2K3RZV65MW3)