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

Oregon 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

197 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$7.7B

Total Claims

165.3M

Unique Providers

6.7K

Watchlist

883

197 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
90837Psytx w pt 60 minutes$501.8M3.5M
99214Office o/p est mod 30 min$470.2M6.9M
99284Emergency dept visit mod mdm$405.4M2.5M
99213Office o/p est low 20 min$376.9M7.4M
99283Emergency dept visit low mdm$312.9M2.4M
99285Emergency dept visit hi mdm$299.8M1.5M
T1020Personal care ser per diem$282.9M241.2K
H0019Behavioral health; long-term residential (non-medical, non-acute care in a$276.5M688.4K
H0004Behavioral health counseling and therapy, per 15 minutes$181.3M2.1M
A0427Als1-emergency$176.8M746.6K
View all procedures β†’