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

Rhode Island 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

109 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$6.9B

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $989.8M / year

Total Claims

71.2M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 10.2M / year

Unique Providers

6.1K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

469

109 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
T2033Res, nos waiver per diem$877.4M496.5K
S5125Attendant care service /15m$650.8M5.5M
T2017Habil res waiver 15 min$381.6M743.4K
T2021Day habil waiver per 15 min$330.6M802.4K
H0019Behavioral health; long-term residential (non-medical, non-acute care in a$242.7M669.2K
H0037Comm psy sup tx pgm per diem$218.0M573.7K
T1019Personal care ser per 15 min$171.7M1.1M
99213Office o/p est low 20 min$148.4M2.8M
T2046Hospice long term care, r&b$146.3M121.4K
80307Drug test prsmv chem anlyzr$134.9M2.9M
View all procedures β†’