Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,281
+29.0% vs peer median
1st highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$4,907,092,673
36th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
290,143
41st highest of 51 states
Most recent CMS monthly report
Visible in claims
16.0%
−23.7% vs peer median
22nd 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 32 flagged Utah providers plus 2 controls. Three referrals, all on pending matters: two behavioral-health operators charged with Medicaid fraud and a dentist under state prosecution. No exclusions or settlements were found on the roster. 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.
$5.2B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $760.6M / year
81.4M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 11.9M / year
4.9K
Distinct billing NPIs, Jan 2018 – Oct 2024
339
46 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| 8888888 | Code 8888888 | $700.2M | 10.1M |
| 90837 | Psytx w pt 60 minutes | $585.0M | 5.7M |
| 97153 | Adaptive behavior tx by tech | $333.9M | 1.6M |
| A0380 | Basic life support mileage | $299.9M | 14.7M |
| H2016 | Comp comm supp svc, per diem | $293.5M | 2.7M |
| 99213 | Office o/p est low 20 min | $249.1M | 4.0M |
| G0463 | Hospital outpt clinic visit | $221.2M | 4.8M |
| H0018 | Behavioral health; short-term residential (non-hospital residential treatment | $201.4M | 755.3K |
| A0429 | Bls-emergency | $197.7M | 1.0M |
| 99214 | Office o/p est mod 30 min | $194.4M | 4.3M |