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

Maine 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

117 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$9.5B

Total Claims

91.7M

Unique Providers

2.6K

Watchlist

426

117 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$2.3B1.4M
H0019Behavioral health; long-term residential (non-medical, non-acute care in a$670.3M1.2M
T1015Clinic service$544.7M3.0M
H2021Com wrap-around sv, 15 min$534.6M1.8M
T1019Personal care ser per 15 min$512.5M2.3M
S5140Adult foster care per diem$421.3M799.3K
T2021Day habil waiver per 15 min$370.1M1.9M
G0463Hospital outpt clinic visit$251.5M4.1M
H0004Behavioral health counseling and therapy, per 15 minutes$233.8M2.9M
H2012Behav hlth day treat, per hr$212.2M914.4K
View all procedures β†’