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

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ $1.2B / year

Total Claims

121.6M

Cumulative, Jan 2018 – Dec 2024 (7 years)

β‰ˆ 17.4M / year

Unique Providers

3.8K

Distinct billing NPIs, Jan 2018 – Dec 2024

Watchlist

403

58 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
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†’