Against 13 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$973
−8.2% vs peer median
9th highest of 14 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$3,508,782,597
42nd highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
256,569
42nd highest of 51 states
Most recent CMS monthly report
Visible in claims
34.7%
+23.3% vs peer median
2nd 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 Rhode Island providers plus 2 controls. Four referrals, all resting on completed public cases: a $10.2M False Claims Act settlement, two convictions for a counseling-billing conspiracy, and a physician's fraud plea. 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.
$6.9B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $1.0B / year
71.2M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 10.4M / year
6.1K
Distinct billing NPIs, Jan 2018 – Oct 2024
386
46 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T2033 | Res, nos waiver per diem | $877.4M | 496.5K |
| S5125 | Attendant care service /15m | $650.8M | 5.5M |
| T2017 | Habil res waiver 15 min | $381.6M | 743.4K |
| T2021 | Day habil waiver per 15 min | $330.6M | 802.4K |
| H0019 | Behavioral health; long-term residential (non-medical, non-acute care in a | $242.7M | 669.2K |
| H0037 | Comm psy sup tx pgm per diem | $218.0M | 573.7K |
| T1019 | Personal care ser per 15 min | $171.7M | 1.1M |
| 99213 | Office o/p est low 20 min | $148.4M | 2.8M |
| T2046 | Hospice long term care, r&b | $146.3M | 121.4K |
| 80307 | Drug test prsmv chem anlyzr | $134.9M | 2.9M |