Against 13 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,243
+25.6% vs peer median
2nd highest of 14 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$94,460,795,749
2nd highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
5,752,512
2nd highest of 51 states
Most recent CMS monthly report
Visible in claims
29.3%
+4.1% vs peer median
7th 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 30 flagged New York providers. No referrals; 27 of 30 are warrants-review, concentrated in Brooklyn and Queens home care, CDPAP fiscal intermediaries, and Article 28 clinics. 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.
$144.8B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $21.2B / year
1.7B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 246.3M / year
59.5K
Distinct billing NPIs, Jan 2018 – Oct 2024
3.3K
752 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $74.6B | 501.7M |
| 99213 | Office o/p est low 20 min | $6.1B | 83.9M |
| T1020 | Personal care ser per diem | $4.6B | 15.1M |
| 99214 | Office o/p est mod 30 min | $3.0B | 33.5M |
| S5126 | Attendant care service /diem | $2.4B | 28.6M |
| G9005 | Mccd, risk adj, maintenance | $2.1B | 6.8M |
| 90834 | Psytx w pt 45 minutes | $2.0B | 15.8M |
| 90832 | Psytx w pt 30 minutes | $1.6B | 14.7M |
| S5105 | Centerbased day care perdiem | $1.5B | 20.4M |
| 99284 | Emergency dept visit mod mdm | $1.0B | 8.1M |