Against 6 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,080
+2.9% vs peer median
4th highest of 7 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$4,526,919,083
38th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
312,287
38th highest of 51 states
Most recent CMS monthly report
Visible in claims
38.4%
−0.1% vs peer median
4th highest of 7 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 36 flagged Maine providers, including 6 seeded from the state's enforcement record. Two referrals: a December 2025 MaineCare payment suspension on a credible allegation of fraud, and a 2024 federal drug-distribution conviction. Maine's January 2023 rate reform and 15-minute unit billing explain most flags. 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.
$9.5B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $1.4B / year
91.7M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 13.4M / year
2.6K
Distinct billing NPIs, Jan 2018 – Oct 2024
208
22 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $2.3B | 1.4M |
| H0019 | Behavioral health; long-term residential (non-medical, non-acute care in a | $670.3M | 1.2M |
| T1015 | Clinic service | $544.7M | 3.0M |
| H2021 | Com wrap-around sv, 15 min | $534.6M | 1.8M |
| T1019 | Personal care ser per 15 min | $512.5M | 2.3M |
| S5140 | Adult foster care per diem | $421.3M | 799.3K |
| T2021 | Day habil waiver per 15 min | $370.1M | 1.9M |
| G0463 | Hospital outpt clinic visit | $251.5M | 4.1M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | $233.8M | 2.9M |
| H2012 | Behav hlth day treat, per hr | $212.2M | 914.4K |