Concourse Sentinel

Medicaid Integrity Analytics

πŸ“ŠOverviewπŸ₯ProvidersπŸ’ŠProceduresπŸ“Rate Benchmarks🚨WatchlistπŸ”Statistical OutliersπŸ—‚οΈReportsπŸ‘₯Population Healthβš–οΈCompareπŸ“ˆTrendsπŸ—ΊοΈGeography

Cross-Dataset

πŸ•ΈοΈEntity Networks🏠Home Healthβ›”Exclusions (LEIE)πŸ“‹Context & Disclaimers
πŸ‡ΊπŸ‡ΈAll States

Federal Compliance (SD)

πŸ›οΈOverviewπŸ“ŠOIG QSRπŸ”„Monthly Screening⏸️§455.23 Suspensionsβ›”OIG Exclusion Refs🧾RAC Coordination🎯PERM Sample
by Concourse

Data: CMS T-MSIS 2018-2024

Source: opendata.hhs.gov

South Dakota 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

26 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$2.5B

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $358.7M / year

Total Claims

22.6M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 3.2M / year

Unique Providers

1.7K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

157

26 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
T2016Habil res waiver per diem$662.6M400.0K
T2048Bh ltc res r&b, per diem$185.7M100.9K
T2020Day habil waiver per diem$177.6M353.0K
99213Office o/p est low 20 min$175.8M1.7M
S0281Medical home, maintenance$62.7M148.7K
99214Office o/p est mod 30 min$57.9M770.7K
T2031Assist living waiver/diem$46.1M42.3K
H2016Comp comm supp svc, per diem$39.5M480.4K
H2021Com wrap-around sv, 15 min$38.9M439.3K
T2025Waiver service, nos$35.3M197.6K
View all procedures β†’