Against 13 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$795
−25.0% vs peer median
14th highest of 14 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$13,226,205,968
24th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
1,207,988
17th highest of 51 states
Most recent CMS monthly report
Visible in claims
26.3%
−10.2% vs peer median
13th 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 Tennessee providers. Three referrals rest on federal convictions with confirmed exclusions; the July 1, 2024 move of 1915(c) waiver billing into MCO encounters explains most of the disability-provider step changes. 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.
$20.4B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $3.0B / year
414.0M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 60.6M / year
12.6K
Distinct billing NPIs, Jan 2018 – Oct 2024
296
28 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T2033 | Res, nos waiver per diem | $3.0B | 9.7M |
| T2023 | Targeted case mgmt per month | $1.1B | 2.6M |
| S0280 | Medical home, initial plan | $853.3M | 5.9M |
| 99214 | Office o/p est mod 30 min | $761.7M | 18.2M |
| T1019 | Personal care ser per 15 min | $760.1M | 8.6M |
| 99213 | Office o/p est low 20 min | $746.9M | 21.4M |
| 99284 | Emergency dept visit mod mdm | $684.5M | 5.9M |
| S5125 | Attendant care service /15m | $603.4M | 5.3M |
| 99283 | Emergency dept visit low mdm | $542.3M | 5.1M |
| T2016 | Habil res waiver per diem | $533.4M | 1.2M |