Against 23 peers — similar data coverage. Comparing to a named peer set rather than a 51-state average.
Spending per member/month
$830
−19.1% vs peer median
18th highest of 24 similar states
CMS-64 total ÷ CMS enrollment
Total Medicaid spending
$4,890,332,627
37th highest of 51 states
CMS-64 Total Net, FY2024
Medicaid enrollment
448,422
35th highest of 51 states
Most recent CMS monthly report
Visible in claims
24.3%
+21.9% vs peer median
1st 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 31 flagged West Virginia providers plus 2 controls. Four referrals, all resting on federal convictions: three physicians convicted of opioid or controlled-substance distribution and one convicted of Medicaid fraud. A physician group's 2025 False Claims Act settlement is also badged. 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.
$8.6B
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ $1.3B / year
121.6M
Cumulative, Jan 2018 – Oct 2024 (6.8 years)
≈ 17.8M / year
3.8K
Distinct billing NPIs, Jan 2018 – Oct 2024
304
26 highest/critical risk
Current (as of latest ETL)
| Code | Description | Total Paid | Claims |
|---|---|---|---|
| S5125 | Attendant care service /15m | $1.6B | 4.0M |
| T1015 | Clinic service | $948.3M | 15.4M |
| 99285 | Emergency dept visit hi mdm | $841.6M | 17.8M |
| S5130 | Homaker service nos per 15m | $509.0M | 2.3M |
| 99213 | Office o/p est low 20 min | $466.7M | 11.7M |
| H2036 | A/d tx program, per diem | $429.9M | 3.7M |
| 99214 | Office o/p est mod 30 min | $414.6M | 8.8M |
| 99284 | Emergency dept visit mod mdm | $377.8M | 9.2M |
| T1019 | Personal care ser per 15 min | $367.1M | 1.7M |
| 87491 | Chlmyd trach dna amp probe | $220.1M | 8.8M |