Against 6 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,135
+11.0% vs peer median
3rd highest of 7 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$23,110,303,360
11th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
1,491,638
13th highest of 51 states
Most recent CMS monthly report
Visible in claims
35.7%
−8.5% vs peer median
7th 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 New Jersey providers. No referrals; one June 2024 State Comptroller Medicaid settlement (no admission) is recorded as context. Most flags trace to health-system group NPIs, bundled-code conversions, and partial-year baselines. 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.
$47.0B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $6.9B / year
784.5M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 114.8M / year
16.1K
Distinct billing NPIs, Jan 2018 – Oct 2024
1.0K
134 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| H2016 | Comp comm supp svc, per diem | $8.7B | 17.7M |
| T1019 | Personal care ser per 15 min | $4.2B | 47.4M |
| S5102 | Adult day care per diem | $2.1B | 25.5M |
| T2021 | Day habil waiver per 15 min | $1.7B | 9.8M |
| T1018 | School-based iep ser bundled | $1.6B | 13.7M |
| 99284 | Emergency dept visit mod mdm | $1.3B | 5.6M |
| 99213 | Office o/p est low 20 min | $1.1B | 23.8M |
| 99283 | Emergency dept visit low mdm | $1.1B | 4.8M |
| T2023 | Targeted case mgmt per month | $997.4M | 1.2M |
| 99214 | Office o/p est mod 30 min | $840.5M | 13.1M |