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

Illinois 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

312 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$19.9B

Total Claims

472.8M

Unique Providers

44.4K

Watchlist

1.4K

312 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$3.3B26.4M
A0427Als1-emergency$1.5B1.6M
A0429Bls-emergency$963.7M1.3M
H0004Behavioral health counseling and therapy, per 15 minutes$774.7M8.6M
99214Office o/p est mod 30 min$720.2M14.9M
H2015Comp comm supp svc, 15 min$582.1M7.1M
99213Office o/p est low 20 min$556.2M23.9M
A0425Ground mileage$269.9M6.4M
H2000Comp multidisipln evaluation$267.5M2.6M
99285Emergency dept visit hi mdm$253.7M2.9M
View all procedures β†’