Against 13 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,061
+7.2% vs peer median
6th highest of 14 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$21,783,535,305
12th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
1,463,881
14th highest of 51 states
Most recent CMS monthly report
Visible in claims
26.1%
−11.1% vs peer median
14th 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 Virginia providers. Two referrals rest on federal criminal cases already on the public record; a third provider's $152.6M personal-care concentration sits inside an unresolved DMAS payment suspension. 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.
$29.5B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $4.3B / year
422.1M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 61.8M / year
15.7K
Distinct billing NPIs, Jan 2018 – Oct 2024
816
27 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $4.7B | 34.7M |
| H2022 | Com wrap-around sv, per diem | $2.3B | 4.8M |
| 99214 | Office o/p est mod 30 min | $2.2B | 52.5M |
| 99283 | Emergency dept visit low mdm | $2.1B | 49.9M |
| H0023 | Alcohol and/or drug outreach | $1.7B | 9.5M |
| H0046 | Mental health service, nos | $1.5B | 8.0M |
| T2033 | Res, nos waiver per diem | $1.4B | 584.2K |
| G0463 | Hospital outpt clinic visit | $860.9M | 13.2M |
| 99213 | Office o/p est low 20 min | $831.3M | 26.8M |
| 99284 | Emergency dept visit mod mdm | $727.5M | 20.1M |