Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$849
−17.2% vs peer median
17th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$12,226,482,492
25th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
1,017,266
25th highest of 51 states
Most recent CMS monthly report
Visible in claims
15.4%
−26.4% vs peer median
23rd 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 30 flagged Wisconsin providers. Four referrals: a $2.3M False Claims Act judgment, a Medicaid fraud conviction, a drug-diversion conviction, and an entity named in a 2023 federal search-warrant affidavit over prenatal care coordination billing. 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.
$9.8B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $1.4B / year
259.3M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 38.0M / year
10.3K
Distinct billing NPIs, Jan 2018 – Oct 2024
304
39 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| H2017 | Psysoc rehab svc, per 15 min | $1.3B | 14.6M |
| 99283 | Emergency dept visit low mdm | $1.0B | 40.5M |
| 99214 | Office o/p est mod 30 min | $827.5M | 32.4M |
| 99213 | Office o/p est low 20 min | $583.2M | 15.6M |
| T1016 | Case management | $384.1M | 5.7M |
| T1015 | Clinic service | $341.3M | 5.8M |
| 81528 | Oncology colorectal scr | $277.2M | 986.0K |
| 97153 | Adaptive behavior tx by tech | $257.7M | 3.1M |
| T2046 | Hospice long term care, r&b | $227.9M | 889.0K |
| 99211 | Off/op est may x req phy/qhp | $190.8M | 6.7M |