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

Virginia 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

511 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$29.5B

Total Claims

422.1M

Unique Providers

15.7K

Watchlist

1.7K

511 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
T1019Personal care ser per 15 min$4.7B34.7M
H2022Com wrap-around sv, per diem$2.3B4.8M
99214Office o/p est mod 30 min$2.2B52.5M
99283Emergency dept visit low mdm$2.1B49.9M
H0023Alcohol and/or drug outreach$1.7B9.5M
H0046Mental health service, nos$1.5B8.0M
T2033Res, nos waiver per diem$1.4B584.2K
G0463Hospital outpt clinic visit$860.9M13.2M
99213Office o/p est low 20 min$831.3M26.8M
99284Emergency dept visit mod mdm$727.5M20.1M
View all procedures β†’