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

Hawaii 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

67 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$3.0B

Total Claims

50.9M

Unique Providers

2.6K

Watchlist

259

67 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
99283Emergency dept visit low mdm$232.6M679.6K
99213Office o/p est low 20 min$193.8M2.2M
99284Emergency dept visit mod mdm$179.5M628.4K
99214Office o/p est mod 30 min$163.3M1.8M
90999Unlisted dialysis procedure$148.7M1.2M
99285Emergency dept visit hi mdm$129.9M392.6K
J0887Epoetin beta esrd use$96.9M84.3K
H2021Com wrap-around sv, 15 min$82.9M209.4K
S9122Home health aide or certifie$80.9M644.0K
T2016Habil res waiver per diem$77.7M66.2K
View all procedures β†’