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

District of Columbia 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

91 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$6.1B

Total Claims

66.1M

Unique Providers

1.4K

Watchlist

239

91 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
T1019Personal care ser per 15 min$1.4B9.8M
H0036Comm psy face-face per 15min$796.1M9.1M
T2016Habil res waiver per diem$559.0M977.1K
T1015Clinic service$188.1M1.7M
H0039Asser com tx face-face/15min$155.9M1.4M
A0429Bls-emergency$136.2M235.2K
99283Emergency dept visit low mdm$124.3M815.2K
99284Emergency dept visit mod mdm$117.3M830.5K
99213Office o/p est low 20 min$99.1M2.0M
99214Office o/p est mod 30 min$98.9M1.3M
View all procedures β†’