Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$765
−25.4% vs peer median
21st highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$9,726,541,323
27th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
850,016
28th highest of 51 states
Most recent CMS monthly report
Visible in claims
18.9%
−9.8% vs peer median
16th 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 31 flagged South Carolina providers plus 2 controls. One referral: a diagnostic laboratory whose operator pleaded guilty to health-care kickbacks. Three excluded individuals and one license revocation carry badges. 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.
$10.3B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $1.5B / year
204.7M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 30.0M / year
8.2K
Distinct billing NPIs, Jan 2018 – Oct 2024
372
35 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $801.3M | 3.2M |
| 99213 | Office o/p est low 20 min | $704.6M | 10.9M |
| 99214 | Office o/p est mod 30 min | $611.5M | 7.7M |
| T1019 | Personal care ser per 15 min | $443.0M | 6.7M |
| 90837 | Psytx w pt 60 minutes | $267.1M | 2.2M |
| T2046 | Hospice long term care, r&b | $249.5M | 71.3K |
| 92507 | Tx sp lang voice comm indiv | $241.9M | 3.2M |
| 97530 | Therapeutic activities | $190.0M | 2.9M |
| T1015 | Clinic service | $185.6M | 7.1M |
| 36415 | Coll venous bld venipuncture | $176.3M | 2.9M |