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

South Dakota 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

47 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$2.5B

Total Claims

22.6M

Unique Providers

1.7K

Watchlist

189

47 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
T2016Habil res waiver per diem$662.6M400.0K
T2048Bh ltc res r&b, per diem$185.7M100.9K
T2020Day habil waiver per diem$177.6M353.0K
99213Office o/p est low 20 min$175.8M1.7M
S0281Medical home, maintenance$62.7M148.7K
99214Office o/p est mod 30 min$57.9M770.7K
T2031Assist living waiver/diem$46.1M42.3K
H2016Comp comm supp svc, per diem$39.5M480.4K
H2021Com wrap-around sv, 15 min$38.9M439.3K
T2025Waiver service, nos$35.3M197.6K
View all procedures β†’