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

West 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

58 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$8.6B

Total Claims

121.6M

Unique Providers

3.8K

Watchlist

403

58 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
S5125Attendant care service /15m$1.6B4.0M
T1015Clinic service$948.3M15.4M
99285Emergency dept visit hi mdm$841.6M17.8M
S5130Homaker service nos per 15m$509.0M2.3M
99213Office o/p est low 20 min$466.7M11.7M
H2036A/d tx program, per diem$429.9M3.7M
99214Office o/p est mod 30 min$414.6M8.8M
99284Emergency dept visit mod mdm$377.8M9.2M
T1019Personal care ser per 15 min$367.1M1.7M
87491Chlmyd trach dna amp probe$220.1M8.8M
View all procedures β†’