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

Vermont 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

33 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$3.0B

Total Claims

26.8M

Unique Providers

1.8K

Watchlist

107

33 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
99199Unlisted special svc px/rprt$1.3B4.2M
T1015Clinic service$246.5M3.6M
H2015Comp comm supp svc, 15 min$225.9M1.5M
H0023Alcohol and/or drug outreach$175.8M928.1K
H0020Alcohol and/or drug services; methadone administration and/or service$169.4M4.1M
H2022Com wrap-around sv, per diem$105.1M118.9K
90837Psytx w pt 60 minutes$94.2M1.3M
99214Office o/p est mod 30 min$71.2M2.3M
T1024Team evaluation & management$68.7M787.2K
H0018Behavioral health; short-term residential (non-hospital residential treatment$40.9M16.7K
View all procedures β†’