Against 13 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,111
+12.2% vs peer median
4th highest of 14 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$1,498,274,373
49th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
124,467
49th highest of 51 states
Most recent CMS monthly report
Visible in claims
34.9%
+24.1% vs peer median
1st 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 6 flagged South Dakota providers plus 2 controls, the smallest roster alongside North Dakota. No referrals and no exclusions: three providers were explained by published rates and policy, three carry routine review items. 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.
$2.5B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $367.5M / year
22.6M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 3.3M / year
1.7K
Distinct billing NPIs, Jan 2018 – Oct 2024
157
18 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $662.6M | 400.0K |
| T2048 | Bh ltc res r&b, per diem | $185.7M | 100.9K |
| T2020 | Day habil waiver per diem | $177.6M | 353.0K |
| 99213 | Office o/p est low 20 min | $175.8M | 1.7M |
| S0281 | Medical home, maintenance | $62.7M | 148.7K |
| 99214 | Office o/p est mod 30 min | $57.9M | 770.7K |
| T2031 | Assist living waiver/diem | $46.1M | 42.3K |
| H2016 | Comp comm supp svc, per diem | $39.5M | 480.4K |
| H2021 | Com wrap-around sv, 15 min | $38.9M | 439.3K |
| T2025 | Waiver service, nos | $35.3M | 197.6K |