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

Idaho 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

58 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$3.6B

Total Claims

63.2M

Unique Providers

3.3K

Watchlist

306

58 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
T1015Clinic service$380.7M2.1M
H0004Behavioral health counseling and therapy, per 15 minutes$255.5M1.8M
T1019Personal care ser per 15 min$202.7M2.7M
99213Office o/p est low 20 min$129.6M3.2M
H2022Com wrap-around sv, per diem$124.7M151.2K
99214Office o/p est mod 30 min$118.9M2.1M
97530Therapeutic activities$109.8M1.6M
H2016Comp comm supp svc, per diem$107.4M62.4K
T2016Habil res waiver per diem$105.5M274.5K
S5125Attendant care service /15m$104.7M936.0K
View all procedures β†’