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

Wisconsin 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

89 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$9.8B

Total Claims

259.3M

Unique Providers

10.3K

Watchlist

519

89 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
H2017Psysoc rehab svc, per 15 min$1.3B14.6M
99283Emergency dept visit low mdm$1.0B40.5M
99214Office o/p est mod 30 min$827.5M32.4M
99213Office o/p est low 20 min$583.2M15.6M
T1016Case management$384.1M5.7M
T1015Clinic service$341.3M5.8M
81528Oncology colorectal scr$277.2M986.0K
97153Adaptive behavior tx by tech$257.7M3.1M
T2046Hospice long term care, r&b$227.9M889.0K
99211Off/op est may x req phy/qhp$190.8M6.7M
View all procedures β†’