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

Ohio 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

531 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$37.0B

Total Claims

867.1M

Unique Providers

21.1K

Watchlist

1.4K

531 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$2.6B37.7M
99214Office o/p est mod 30 min$1.7B28.0M
99213Office o/p est low 20 min$1.7B38.4M
H2019Ther behav svc, per 15 min$1.5B17.4M
T2046Hospice long term care, r&b$1.3B8.6M
G0156Hhcp-svs of aide,ea 15 min$1.2B34.9M
H0015Alcohol and/or drug services; intensive outpatient (treatment program that$1.2B7.7M
90837Psytx w pt 60 minutes$1.1B12.6M
99284Emergency dept visit mod mdm$970.7M10.8M
G0463Hospital outpt clinic visit$889.8M9.2M
View all procedures β†’