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

Kentucky 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

198 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$23.6B

Total Claims

419.7M

Unique Providers

10.3K

Watchlist

792

198 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
S5108Homecare train pt 15 min$1.7B11.6M
T2016Habil res waiver per diem$1.7B8.5M
97535Self care mngment training$1.1B9.3M
99213Office o/p est low 20 min$993.3M30.9M
99284Emergency dept visit mod mdm$860.1M5.9M
99285Emergency dept visit hi mdm$611.2M4.1M
99214Office o/p est mod 30 min$605.4M13.7M
90837Psytx w pt 60 minutes$566.6M7.5M
99283Emergency dept visit low mdm$566.0M4.8M
T1019Personal care ser per 15 min$565.2M4.1M
View all procedures β†’