Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProceduresπŸ“Rate Benchmarks🚨WatchlistπŸ”Statistical OutliersπŸ—‚οΈReportsπŸ‘₯Population Healthβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States

Federal Compliance (ME)

πŸ›οΈOverviewπŸ“ŠOIG QSRπŸ”„Monthly Screening⏸️§455.23 Suspensionsβ›”OIG Exclusion Refs🧾RAC Coordination🎯PERM Sample
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

51 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

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $1.4B / year

Total Claims

91.7M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 13.1M / year

Unique Providers

2.6K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

203

51 highest/critical risk

Current (as of latest ETL)

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†’