Against 13 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$893
−15.7% vs peer median
11th highest of 14 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$7,923,702,120
31st highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
636,907
32nd highest of 51 states
Most recent CMS monthly report
Visible in claims
31.0%
+10.2% vs peer median
4th highest of 14 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 32 flagged New Mexico providers, including 2 seeded from the state's enforcement record. Two referrals: a transportation company named in a June 2026 federal forfeiture complaint and an equine-therapy provider whose owner pleaded guilty to Medicaid fraud. New Mexico's October 2022 rate lift and Turquoise Care launch explain most growth 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.
$13.7B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $2.0B / year
169.9M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 24.9M / year
4.2K
Distinct billing NPIs, Jan 2018 – Oct 2024
563
105 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| 99509 | Home visit day life activity | $1.3B | 4.3M |
| T1019 | Personal care ser per 15 min | $1.2B | 16.9M |
| T2016 | Habil res waiver per diem | $883.7M | 2.5M |
| 99213 | Office o/p est low 20 min | $487.0M | 5.8M |
| 99214 | Office o/p est mod 30 min | $472.9M | 5.3M |
| T2033 | Res, nos waiver per diem | $421.6M | 1.5M |
| 90837 | Psytx w pt 60 minutes | $334.2M | 2.8M |
| 99284 | Emergency dept visit mod mdm | $299.0M | 1.9M |
| H2021 | Com wrap-around sv, 15 min | $270.7M | 786.1K |
| 99285 | Emergency dept visit hi mdm | $248.0M | 1.2M |