Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$993
−3.2% vs peer median
13th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$148,772,636,090
1st highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
10,577,595
1st highest of 51 states
Most recent CMS monthly report
Visible in claims
16.7%
−20.5% vs peer median
19th highest of 24 similar states
Share of program these claims see
Published figures are FY2024 CMS-64 and CMS enrollment. Claims figures cover 2018–2024.
Public-record research has been run on 40 flagged California providers, including 10 seeded from the state's enforcement record. Three referrals; Kaiser's January 1, 2024 direct Medi-Cal contract and CalAIM program launches explain most of the largest step changes. Methodology
CMS T-MSIS data, 2018-2024
Concourse Sentinel connects to large-scale healthcare billing datasets — including CMS T-MSIS claims, provider enrollment (PECOS), and federal exclusion lists — and runs millions of automated statistical analyses to surface billing anomalies and areas warranting further review.
$129.5B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $19.0B / year
2.6B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 373.2M / year
53.2K
Distinct billing NPIs, Jan 2018 – Oct 2024
5.3K
848 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T1015 | Clinic service | $21.8B | 115.2M |
| H2015 | Comp comm supp svc, 15 min | $8.4B | 33.7M |
| 00003 | Code 00003 | $5.3B | 20.2M |
| S5102 | Adult day care per diem | $3.3B | 44.5M |
| 90999 | Unlisted dialysis procedure | $3.3B | 21.7M |
| H2010 | Comprehensive med svc 15 min | $3.2B | 12.0M |
| H2017 | Psysoc rehab svc, per 15 min | $3.0B | 13.7M |
| T1017 | Targeted case management | $2.6B | 14.9M |
| 99214 | Office o/p est mod 30 min | $2.3B | 60.4M |
| H2019 | Ther behav svc, per 15 min | $2.1B | 15.1M |