Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$1,100
+10.8% vs peer median
6th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$2,132,603,719
48th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
142,134
48th highest of 51 states
Most recent CMS monthly report
Visible in claims
23.9%
+19.9% vs peer median
2nd 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 21 flagged Vermont providers plus 2 controls. Four referrals rest on a $2.73M False Claims Act judgment, a fraud plea, a $200,000 settlement, and a pending felony prosecution. Vermont's Medicaid Fraud Unit has been unusually active, and six of its recent cases matched providers in the source data. 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.
$3.0B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $434.7M / year
26.8M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 3.9M / year
1.8K
Distinct billing NPIs, Jan 2018 – Oct 2024
77
11 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| 99199 | Unlisted special svc px/rprt | $1.3B | 4.2M |
| T1015 | Clinic service | $246.5M | 3.6M |
| H2015 | Comp comm supp svc, 15 min | $225.9M | 1.5M |
| H0023 | Alcohol and/or drug outreach | $175.8M | 928.1K |
| H0020 | Alcohol and/or drug services; methadone administration and/or service | $169.4M | 4.1M |
| H2022 | Com wrap-around sv, per diem | $105.1M | 118.9K |
| 90837 | Psytx w pt 60 minutes | $94.2M | 1.3M |
| 99214 | Office o/p est mod 30 min | $71.2M | 2.3M |
| T1024 | Team evaluation & management | $68.7M | 787.2K |
| H0018 | Behavioral health; short-term residential (non-hospital residential treatment | $40.9M | 16.7K |