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

Pennsylvania 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

852 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$27.9B

Total Claims

356.7M

Unique Providers

30.9K

Watchlist

2.2K

852 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
W1793Code W1793$2.2B12.8M
T1015Clinic service$2.0B11.8M
H2036A/d tx program, per diem$1.0B2.5M
S9124Nursing care, in the home; b$846.8M1.5M
90834Psytx w pt 45 minutes$702.1M8.6M
W7210Code W7210$686.9M8.4M
99284Emergency dept visit mod mdm$657.6M5.3M
97153Adaptive behavior tx by tech$592.5M2.7M
T1017Targeted case management$591.1M6.2M
99214Office o/p est mod 30 min$560.0M10.0M
View all procedures β†’