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

Texas 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

1047 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$56.3B

Total Claims

1.1B

Unique Providers

31.4K

Watchlist

3.4K

1047 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
S5125Attendant care service /15m$17.2B295.4M
T1000Private duty/independent nsg$3.8B10.5M
H2016Comp comm supp svc, per diem$3.8B30.2M
99213Office o/p est low 20 min$3.2B107.4M
99284Emergency dept visit mod mdm$2.8B38.5M
T1015Clinic service$2.6B35.7M
T1019Personal care ser per 15 min$1.7B95.4M
92507Tx sp lang voice comm indiv$1.4B16.0M
T2016Habil res waiver per diem$1.3B9.2M
99214Office o/p est mod 30 min$1.3B53.8M
View all procedures β†’