Against 13 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,367
+38.1% vs peer median
1st highest of 14 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$4,137,819,497
39th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
222,823
44th highest of 51 states
Most recent CMS monthly report
Visible in claims
26.9%
−8.2% vs peer median
11th highest of 14 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 31 flagged District of Columbia providers, including 1 seeded from the enforcement record. Three referrals: a federal jury conviction and two pending federal charges naming behavioral-health billers. A cluster of unexplained November 2021 volume steps at certified Core Service Agencies is the District's main open pattern. 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.
$6.1B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $893.8M / year
66.1M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 9.7M / year
1.4K
Distinct billing NPIs, Jan 2018 – Oct 2024
167
40 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $1.4B | 9.8M |
| H0036 | Comm psy face-face per 15min | $796.1M | 9.1M |
| T2016 | Habil res waiver per diem | $559.0M | 977.1K |
| T1015 | Clinic service | $188.1M | 1.7M |
| H0039 | Asser com tx face-face/15min | $155.9M | 1.4M |
| A0429 | Bls-emergency | $136.2M | 235.2K |
| 99283 | Emergency dept visit low mdm | $124.3M | 815.2K |
| 99284 | Emergency dept visit mod mdm | $117.3M | 830.5K |
| 99213 | Office o/p est low 20 min | $99.1M | 2.0M |
| 99214 | Office o/p est mod 30 min | $98.9M | 1.3M |