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

New York 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

1504 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$144.8B

Total Claims

1.7B

Unique Providers

59.5K

Watchlist

4.5K

1504 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
T1019Personal care ser per 15 min$74.6B501.7M
99213Office o/p est low 20 min$6.1B83.9M
T1020Personal care ser per diem$4.6B15.1M
99214Office o/p est mod 30 min$3.0B33.5M
S5126Attendant care service /diem$2.4B28.6M
G9005Mccd, risk adj, maintenance$2.1B6.8M
90834Psytx w pt 45 minutes$2.0B15.8M
90832Psytx w pt 30 minutes$1.6B14.7M
S5105Centerbased day care perdiem$1.5B20.4M
99284Emergency dept visit mod mdm$1.0B8.1M
View all procedures β†’