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

Massachusetts 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

380 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$56.1B

Total Claims

790.6M

Unique Providers

19.4K

Watchlist

1.6K

380 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
T2016Habil res waiver per diem$9.0B890.8K
T1019Personal care ser per 15 min$8.4B97.0M
S5140Adult foster care per diem$3.1B29.6M
S5102Adult day care per diem$1.4B13.2M
99214Office o/p est mod 30 min$1.1B15.9M
90834Psytx w pt 45 minutes$969.9M12.7M
T1502Medication admin visit$952.5M16.2M
99213Office o/p est low 20 min$875.3M15.6M
T2025Waiver service, nos$864.7M5.4M
T1015Clinic service$851.8M5.9M
View all procedures β†’