Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,175
+18.3% vs peer median
4th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$8,689,318,601
29th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
589,894
33rd highest of 51 states
Most recent CMS monthly report
Visible in claims
23.4%
+17.5% vs peer median
6th 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 39 flagged Iowa providers, including 9 seeded from the state's enforcement record. Three referrals rest on federal convictions with confirmed exclusions; a January 2024 cluster of home-health agencies pivoting from homemaker to skilled billing is the 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.
$11.7B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $1.7B / year
174.4M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 25.5M / year
6.9K
Distinct billing NPIs, Jan 2018 – Oct 2024
290
21 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| H2016 | Comp comm supp svc, per diem | $2.7B | 6.8M |
| S5136 | Adult companioncare per diem | $1.5B | 3.0M |
| T1015 | Clinic service | $932.0M | 5.4M |
| S5170 | Homedelivered prepared meal | $882.5M | 49.9M |
| T2020 | Day habil waiver per diem | $308.0M | 2.8M |
| 90834 | Psytx w pt 45 minutes | $232.2M | 3.2M |
| 99284 | Emergency dept visit mod mdm | $223.0M | 1.6M |
| 99490 | Chrnc care mgmt staff 1st 20 | $216.9M | 1.5M |
| 99213 | Office o/p est low 20 min | $203.1M | 8.4M |
| G0463 | Hospital outpt clinic visit | $198.0M | 2.2M |