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

Utah 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

97 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$5.2B

Total Claims

81.4M

Unique Providers

4.9K

Watchlist

439

97 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
8888888Code 8888888$700.2M10.1M
90837Psytx w pt 60 minutes$585.0M5.7M
97153Adaptive behavior tx by tech$333.9M1.6M
A0380Basic life support mileage$299.9M14.7M
H2016Comp comm supp svc, per diem$293.5M2.7M
99213Office o/p est low 20 min$249.1M4.0M
G0463Hospital outpt clinic visit$221.2M4.8M
H0018Behavioral health; short-term residential (non-hospital residential treatment$201.4M755.3K
A0429Bls-emergency$197.7M1.0M
99214Office o/p est mod 30 min$194.4M4.3M
View all procedures β†’