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

Iowa 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

89 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$11.7B

Total Claims

174.4M

Unique Providers

6.9K

Watchlist

467

89 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
H2016Comp comm supp svc, per diem$2.7B6.8M
S5136Adult companioncare per diem$1.5B3.0M
T1015Clinic service$932.0M5.4M
S5170Homedelivered prepared meal$882.5M49.9M
T2020Day habil waiver per diem$308.0M2.8M
90834Psytx w pt 45 minutes$232.2M3.2M
99284Emergency dept visit mod mdm$223.0M1.6M
99490Chrnc care mgmt staff 1st 20$216.9M1.5M
99213Office o/p est low 20 min$203.1M8.4M
G0463Hospital outpt clinic visit$198.0M2.2M
View all procedures β†’