The federal government's $94 billion evidence problem
CMS, the VA, FDA, NIH, and Medicaid are all making AI-assisted decisions that regulators require to be traceable to specific evidence. Most of the AI infrastructure being deployed today cannot satisfy that requirement. Skippy is built for it — with FedRAMP readiness, OMB M-24-10 compliant audit trails, and HIPAA BAA.
Where the waste is — and the product for each
Each opportunity maps to an existing Skippy product. Waste figures are federal government estimates from CMS, GAO, and OIG published data.
| Agency | Program | Addressable waste | Skippy product | Deadline / status |
|---|---|---|---|---|
| CMS | Prior Authorization | $20–35B/yr | Skippy Auth | Jan 2027 |
| NIH / Medicaid | Rare Disease Diagnosis | $40–80B/yr | Skippy Rare | Ongoing |
| FDA CDER | Pharmacovigilance | $6–18B/yr | Skippy Pharmacovigilance | Ongoing |
| HHS OIG / CMS | Medicaid Fraud & Improper Payments | $6–16B/yr | Skippy Fraud | Ongoing |
| VA / Medicare | Adverse Drug Events | $9–17B/yr | Skippy DDI + Med-Check | Ongoing |
| VA | Million Veteran Program Genomics | $1.7–3.6B/yr | Skippy Variants | Ongoing |
| NIH | Clinical Trial Efficiency | $7–13B/yr | Skippy Drug Discovery | Ongoing |
| All agencies | Federal AI Compliance Infrastructure | $800M–2.3B (5yr) | Skippy Federal | OMB M-24-10 |
Product for every agency, evidence layer for all
Centers for Medicare & Medicaid Services (CMS)
Prior authorization compliance (CMS-0057-F), pre-payment clinical plausibility screening, evidence grounding for coverage decisions.
January 1, 2027 full PA compliance
Department of Veterans Affairs (VA)
Polypharmacy safety for 9M enrolled veterans (65% on 5+ medications), genomic variant interpretation for the Million Veteran Program, rare disease diagnosis support.
Active need — Oracle Health migration creating integration window
FDA / Center for Drug Evaluation and Research
Mechanism-based signal detection against FAERS 2.1M annual reports, retraction monitoring, pre-market evidence synthesis.
Ongoing — PDUFA VII performance goals
NIH / NCATS
Rare disease phenotype matching for the Undiagnosed Diseases Network, natural history synthesis, clinical trial efficiency.
Ongoing — NIH NCATS CTSA network
All Federal Agencies (OMB coordination)
Shared FedRAMP-authorized evidence infrastructure — 15+ agencies independently building AI compliance layer. One shared deployment eliminates duplication.
OMB M-24-10 active
Product details →Built for federal deployment requirements
FedRAMP High pathway
Skippy's architecture is designed for FedRAMP High authorization — the level required for systems handling Protected Health Information (PHI) and Controlled Unclassified Information (CUI). Government deployments run in agency-scoped isolation with a shared evidence layer.
OMB M-24-10 compliant audit trail
Every AI-assisted decision generates a structured federal audit record with agency ID, decision ID, evidence source, confidence, and cryptographic chain-of-custody. Satisfies OMB M-24-10 high-risk AI requirements without post-processing.
HIPAA BAA available
Full Business Associate Agreements available for all federal health program deployments. API is designed to operate without receiving PHI — queries use normalized clinical identifiers (RxNorm, ICD-10), not patient data.
FISMA-aligned security
AES-256 encryption at rest, TLS 1.3 in transit, VPC isolation, immutable audit logs with 7-year retention. Infrastructure controls map to NIST SP 800-53 moderate and high baselines.
“Where AI or algorithms are used to support prior authorization decisions, the rationale produced by the AI system must be traceable to specific clinical criteria that are publicly available and versioned.”
CMS-0057-F preamble · Interoperability and Prior Authorization Final Rule · Effective January 2027
An LLM cannot satisfy this requirement — its rationale is not traceable to any named, versioned criterion. Skippy Auth returns a specific source document ID, version date, and evidence citation with every decision.
Skippy Auth product details →Working in federal health AI?
We work with federal agencies, government contractors, and health IT vendors serving federal programs. Let's talk about your compliance and evidence requirements.