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

North Carolina 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

332 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$34.9B

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $5.0B / year

Total Claims

823.1M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 117.6M / year

Unique Providers

17.0K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

2.2K

332 highest/critical risk

Current (as of latest ETL)

Monthly Spending Trend
Top 10 Providers by Spending
View all providers β†’
Spending by Category
Top 10 Procedures by Spending
CodeDescriptionTotal PaidClaims
99509Home visit day life activity$3.4B62.1M
T2013Habil ed waiver per hour$1.7B11.4M
99214Office o/p est mod 30 min$1.2B19.5M
S5125Attendant care service /15m$1.2B11.6M
T1000Private duty/independent nsg$1.2B2.9M
99199Unlisted special svc px/rprt$942.5M165.4M
T2021Day habil waiver per 15 min$934.8M7.4M
99213Office o/p est low 20 min$917.3M19.5M
99284Emergency dept visit mod mdm$869.1M6.6M
H2022Com wrap-around sv, per diem$716.7M2.5M
View all procedures β†’