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

Delaware 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

68 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$4.0B

Total Claims

61.6M

Unique Providers

1.9K

Watchlist

275

68 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
S5130Homaker service nos per 15m$530.8M4.0M
T2025Waiver service, nos$508.0M768.8K
T2016Habil res waiver per diem$204.5M333.5K
S9124Nursing care, in the home; b$177.2M551.8K
99214Office o/p est mod 30 min$118.1M2.3M
99213Office o/p est low 20 min$100.3M2.6M
S5125Attendant care service /15m$99.6M738.1K
99283Emergency dept visit low mdm$88.2M784.6K
S9123Nursing care in home rn$75.5M225.1K
T2020Day habil waiver per diem$69.8M606.2K
View all procedures β†’