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

Michigan 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

343 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$38.9B

Total Claims

668.9M

Unique Providers

16.8K

Watchlist

1.3K

343 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
H2015Comp comm supp svc, 15 min$3.7B39.3M
H2016Comp comm supp svc, per diem$2.6B8.4M
T1017Targeted case management$1.4B6.6M
99214Office o/p est mod 30 min$1.3B18.5M
T1019Personal care ser per 15 min$1.2B16.9M
99213Office o/p est low 20 min$1.2B24.8M
99285Emergency dept visit hi mdm$1.1B5.5M
T1020Personal care ser per diem$1.0B5.9M
97153Adaptive behavior tx by tech$995.8M5.3M
99284Emergency dept visit mod mdm$812.6M7.1M
View all procedures β†’