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

Georgia 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

49 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$5.8B

Total Claims

122.9M

Unique Providers

3.7K

Watchlist

219

49 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
S5125Attendant care service /15m$477.7M5.5M
99213Office o/p est low 20 min$331.0M5.1M
T2033Res, nos waiver per diem$304.1M684.1K
99285Emergency dept visit hi mdm$259.4M914.9K
T1019Personal care ser per 15 min$235.6M2.7M
T2025Waiver service, nos$224.6M1.7M
99284Emergency dept visit mod mdm$216.5M1.3M
99214Office o/p est mod 30 min$202.3M3.1M
99283Emergency dept visit low mdm$184.7M1.6M
T2017Habil res waiver 15 min$165.5M936.4K
View all procedures β†’