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

Washington 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

134 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$16.7B

Total Claims

358.4M

Unique Providers

8.2K

Watchlist

592

134 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
T1015Clinic service$3.8B36.0M
99214Office o/p est mod 30 min$1.4B30.5M
G0463Hospital outpt clinic visit$1.0B28.5M
99283Emergency dept visit low mdm$934.5M23.4M
96361Hydrate iv infusion add-on$815.5M28.2M
99213Office o/p est low 20 min$656.0M19.6M
A0999Unlisted ambulance service$433.9M1.1M
H0018Behavioral health; short-term residential (non-hospital residential treatment$413.6M3.3M
99284Emergency dept visit mod mdm$389.3M5.5M
90837Psytx w pt 60 minutes$359.7M6.0M
View all procedures β†’