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

Rhode Island 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

109 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$6.9B

Total Claims

71.2M

Unique Providers

6.1K

Watchlist

469

109 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
T2033Res, nos waiver per diem$877.4M496.5K
S5125Attendant care service /15m$650.8M5.5M
T2017Habil res waiver 15 min$381.6M743.4K
T2021Day habil waiver per 15 min$330.6M802.4K
H0019Behavioral health; long-term residential (non-medical, non-acute care in a$242.7M669.2K
H0037Comm psy sup tx pgm per diem$218.0M573.7K
T1019Personal care ser per 15 min$171.7M1.1M
99213Office o/p est low 20 min$148.4M2.8M
T2046Hospice long term care, r&b$146.3M121.4K
80307Drug test prsmv chem anlyzr$134.9M2.9M
View all procedures β†’