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

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

511 critical

providers flagged

Home Health

Deep Dive

outlier analysis

Entity Networks

AO Analysis

shared ownership detection

Exclusions

LEIE Matches

post-exclusion billing

Total Spending

$29.5B

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $4.2B / year

Total Claims

422.1M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 60.3M / year

Unique Providers

15.7K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

1.7K

511 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
T1019Personal care ser per 15 min$4.7B34.7M
H2022Com wrap-around sv, per diem$2.3B4.8M
99214Office o/p est mod 30 min$2.2B52.5M
99283Emergency dept visit low mdm$2.1B49.9M
H0023Alcohol and/or drug outreach$1.7B9.5M
H0046Mental health service, nos$1.5B8.0M
T2033Res, nos waiver per diem$1.4B584.2K
G0463Hospital outpt clinic visit$860.9M13.2M
99213Office o/p est low 20 min$831.3M26.8M
99284Emergency dept visit mod mdm$727.5M20.1M
View all procedures β†’