Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProcedures🚨WatchlistπŸ”Statistical Outliersβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

Alabama Medicaid Provider Spending

CMS T-MSIS data, 2018-2024

Concourse Sentinel connects to large-scale healthcare billing datasets β€” including CMS T-MSIS claims, provider enrollment (PECOS), and federal exclusion lists β€” and runs millions of automated statistical analyses to surface billing anomalies and areas warranting further review.

Cross-Dataset Analysis Available

Watchlist

34 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$10.3B

Total Claims

200.8M

Unique Providers

6.6K

Watchlist

307

34 highest/critical risk

Monthly Spending Trend
Top 10 Providers by Spending
View all providers β†’
Spending by Category
Top 10 Procedures by Spending
CodeDescriptionTotal PaidClaims
T2016Habil res waiver per diem$1.8B477.6K
T1015Clinic service$700.3M5.9M
T1019Personal care ser per 15 min$627.9M3.5M
99214Office o/p est mod 30 min$401.7M7.1M
99213Office o/p est low 20 min$369.1M8.9M
H0036Comm psy face-face per 15min$338.8M4.8M
81479Unlisted molecular pathology$267.9M168.8K
T2021Day habil waiver per 15 min$211.7M520.3K
99284Emergency dept visit mod mdm$192.2M3.1M
A0431Rotary wing air transport$176.1M105.9K
View all procedures β†’