Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$608
−40.7% vs peer median
24th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$3,048,230,386
44th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
366,500
36th highest of 51 states
Most recent CMS monthly report
Visible in claims
17.2%
−18.1% vs peer median
18th 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 30 flagged Hawaii providers. One referral, a Kihei physician's 2019 fraud conviction. Twenty-one of the thirty are dialysis facilities in two chains whose paid amounts jumped 10x to 30x on flat volume in September and October 2024, a statewide payment event that no published rate explains and that dominates Hawaii's watchlist. 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.
$3.0B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $439.6M / year
50.9M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 7.4M / year
2.6K
Distinct billing NPIs, Jan 2018 – Oct 2024
188
39 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| 99283 | Emergency dept visit low mdm | $232.6M | 679.6K |
| 99213 | Office o/p est low 20 min | $193.8M | 2.2M |
| 99284 | Emergency dept visit mod mdm | $179.5M | 628.4K |
| 99214 | Office o/p est mod 30 min | $163.3M | 1.8M |
| 90999 | Unlisted dialysis procedure | $148.7M | 1.2M |
| 99285 | Emergency dept visit hi mdm | $129.9M | 392.6K |
| J0887 | Epoetin beta esrd use | $96.9M | 84.3K |
| H2021 | Com wrap-around sv, 15 min | $82.9M | 209.4K |
| S9122 | Home health aide or certifie | $80.9M | 644.0K |
| T2016 | Habil res waiver per diem | $77.7M | 66.2K |