Against 6 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$918
−17.1% vs peer median
7th highest of 7 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$2,369,609,304
47th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
181,100
46th highest of 51 states
Most recent CMS monthly report
Visible in claims
43.8%
+15.7% vs peer median
1st 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 30 flagged Montana providers. Eight of the flagged individuals are on the OIG or Montana exclusion lists; all stopped billing before their exclusion dates. 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.
$5.4B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $786.0M / year
74.9M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 11.0M / year
3.4K
Distinct billing NPIs, Jan 2018 – Oct 2024
185
1 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| S5126 | Attendant care service /diem | $1.8B | 18.1M |
| T1019 | Personal care ser per 15 min | $553.0M | 4.1M |
| T2017 | Habil res waiver 15 min | $276.9M | 55.7K |
| S5150 | Unskilled respite care /15m | $234.0M | 3.1M |
| 90837 | Psytx w pt 60 minutes | $172.4M | 2.2M |
| H0036 | Comm psy face-face per 15min | $147.1M | 1.7M |
| 99214 | Office o/p est mod 30 min | $120.1M | 1.7M |
| T2021 | Day habil waiver per 15 min | $118.1M | 116.7K |
| 99213 | Office o/p est low 20 min | $103.0M | 2.3M |
| S5145 | Child fostercare th per diem | $98.5M | 429.9K |