Against 5 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$913
−3.3% vs peer median
4th highest of 6 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$20,038,047,659
13th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
1,727,218
10th highest of 51 states
Most recent CMS monthly report
Visible in claims
14.1%
+52.3% vs peer median
2nd highest of 6 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 Washington providers. No referrals; seven individuals carry confirmed federal exclusions, six of them license-based, all with de minimis billing that ended before the exclusion took effect. 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.
$16.7B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $2.4B / year
358.4M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 52.5M / year
8.2K
Distinct billing NPIs, Jan 2018 – Oct 2024
381
59 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| T1015 | Clinic service | $3.8B | 36.0M |
| 99214 | Office o/p est mod 30 min | $1.4B | 30.5M |
| G0463 | Hospital outpt clinic visit | $1.0B | 28.5M |
| 99283 | Emergency dept visit low mdm | $934.5M | 23.4M |
| 96361 | Hydrate iv infusion add-on | $815.5M | 28.2M |
| 99213 | Office o/p est low 20 min | $656.0M | 19.6M |
| A0999 | Unlisted ambulance service | $433.9M | 1.1M |
| H0018 | Behavioral health; short-term residential (non-hospital residential treatment | $413.6M | 3.3M |
| 99284 | Emergency dept visit mod mdm | $389.3M | 5.5M |
| 90837 | Psytx w pt 60 minutes | $359.7M | 6.0M |