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

Indiana 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

164 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$17.4B

Total Claims

328.0M

Unique Providers

10.2K

Watchlist

730

164 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
H2014Skills train and dev, 15 min$1.7B13.2M
99214Office o/p est mod 30 min$956.7M15.2M
T2016Habil res waiver per diem$955.1M1.5M
99213Office o/p est low 20 min$897.4M18.8M
97153Adaptive behavior tx by tech$735.4M1.7M
H0010Alcohol and/or drug services; sub-acute detoxification (residential addiction$728.4M1.9M
99284Emergency dept visit mod mdm$580.5M5.8M
99283Emergency dept visit low mdm$547.3M5.1M
99600Unlisted home visit svc/px$495.1M4.5M
99285Emergency dept visit hi mdm$359.5M3.7M
View all procedures β†’