Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,212
+22.1% vs peer median
3rd highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$43,221,817,294
4th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
2,701,242
5th highest of 51 states
Most recent CMS monthly report
Visible in claims
16.0%
−23.5% vs peer median
21st 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 Pennsylvania providers. No referrals; most growth flags are a $0-paid to paid encounter-reporting break in HealthChoices behavioral-health data at January 2022, not real growth. 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.
$27.9B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $4.1B / year
356.7M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 52.2M / year
30.9K
Distinct billing NPIs, Jan 2018 – Oct 2024
1.4K
370 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| W1793 | Code W1793 | $2.2B | 12.8M |
| T1015 | Clinic service | $2.0B | 11.8M |
| H2036 | A/d tx program, per diem | $1.0B | 2.5M |
| S9124 | Nursing care, in the home; b | $846.8M | 1.5M |
| 90834 | Psytx w pt 45 minutes | $702.1M | 8.6M |
| W7210 | Code W7210 | $686.9M | 8.4M |
| 99284 | Emergency dept visit mod mdm | $657.6M | 5.3M |
| 97153 | Adaptive behavior tx by tech | $592.5M | 2.7M |
| T1017 | Targeted case management | $591.1M | 6.2M |
| 99214 | Office o/p est mod 30 min | $560.0M | 10.0M |