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

California 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

1673 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$129.5B

Total Claims

2.6B

Unique Providers

53.2K

Watchlist

6.9K

1673 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
T1015Clinic service$21.8B115.2M
H2015Comp comm supp svc, 15 min$8.4B33.7M
00003Code 00003$5.3B20.2M
S5102Adult day care per diem$3.3B44.5M
90999Unlisted dialysis procedure$3.3B21.7M
H2010Comprehensive med svc 15 min$3.2B12.0M
H2017Psysoc rehab svc, per 15 min$3.0B13.7M
T1017Targeted case management$2.6B14.9M
99214Office o/p est mod 30 min$2.3B60.4M
H2019Ther behav svc, per 15 min$2.1B15.1M
View all procedures β†’