Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,036
+4.4% vs peer median
8th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$28,887,230,741
8th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
2,486,253
7th highest of 51 states
Most recent CMS monthly report
Visible in claims
23.7%
+19.1% vs peer median
3rd 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 North Carolina providers. One referral rests on two federal convictions already on the public record; twelve flags resolve to Medicaid expansion, Tailored Care Management, and OTP bundle repricing. 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.
$34.9B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $5.1B / year
823.1M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 120.5M / year
17.0K
Distinct billing NPIs, Jan 2018 – Oct 2024
673
79 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| 99509 | Home visit day life activity | $3.4B | 62.1M |
| T2013 | Habil ed waiver per hour | $1.7B | 11.4M |
| 99214 | Office o/p est mod 30 min | $1.2B | 19.5M |
| S5125 | Attendant care service /15m | $1.2B | 11.6M |
| T1000 | Private duty/independent nsg | $1.2B | 2.9M |
| 99199 | Unlisted special svc px/rprt | $942.5M | 165.4M |
| T2021 | Day habil waiver per 15 min | $934.8M | 7.4M |
| 99213 | Office o/p est low 20 min | $917.3M | 19.5M |
| 99284 | Emergency dept visit mod mdm | $869.1M | 6.6M |
| H2022 | Com wrap-around sv, per diem | $716.7M | 2.5M |