Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,111
+11.9% vs peer median
5th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$17,878,704,523
17th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
1,164,950
19th highest of 51 states
Most recent CMS monthly report
Visible in claims
23.5%
+17.9% vs peer median
5th 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 Kentucky providers; see the Research chips on the watchlist and provider pages. 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.
$23.6B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $3.4B / year
419.7M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 61.4M / year
10.3K
Distinct billing NPIs, Jan 2018 – Oct 2024
440
66 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| S5108 | Homecare train pt 15 min | $1.7B | 11.6M |
| T2016 | Habil res waiver per diem | $1.7B | 8.5M |
| 97535 | Self care mngment training | $1.1B | 9.3M |
| 99213 | Office o/p est low 20 min | $993.3M | 30.9M |
| 99284 | Emergency dept visit mod mdm | $860.1M | 5.9M |
| 99285 | Emergency dept visit hi mdm | $611.2M | 4.1M |
| 99214 | Office o/p est mod 30 min | $605.4M | 13.7M |
| 90837 | Psytx w pt 60 minutes | $566.6M | 7.5M |
| 99283 | Emergency dept visit low mdm | $566.0M | 4.8M |
| T1019 | Personal care ser per 15 min | $565.2M | 4.1M |