Guide
Medicaid Fraud by State
Which states have the most flagged providers? Where are the biggest concentrations of billing anomalies? A state-by-state breakdown.
The Big Picture
Medicaid fraud isn't evenly distributed. Our analysis of 227 million billing records flagged 1,860 providers across all 50 states — but some states have dramatically higher concentrations of suspicious billing patterns than others.
New York leads in absolute flags (159), while Vermont leads per capita (1.08 per 100K residents). Arizona stands out for its cluster of brand-new providers that appeared post-pandemic.
State Breakdown
New York
159 flagsHome care industry dominates. Brooklyn alone has 64 flagged providers.
$64.2B
0.82/100K
California
87 flagsCounty-level mental health programs and large hospital systems.
$29.8B
0.22/100K
Arizona
71 flags46 brand-new providers appeared post-pandemic. Major new-entrant cluster.
$5.1B
0.97/100K
Massachusetts
52 flagsDDS entities billing 37-51× median for residential habilitation.
$15.2B
0.75/100K
Illinois
38 flagsCity of Chicago ambulance billing surged 942% during COVID.
$11.8B
0.30/100K
Tennessee
31 flagsNashville-based state disability programs with consistently high billing.
$7.2B
0.45/100K
Vermont
7 flagsHighest per-capita risk flag rate in the country despite small size.
$1.1B
1.08/100K
Florida
29 flagsLarge state with relatively low flag rate per capita.
$7.9B
0.13/100K
Key Patterns
New York Dominance
New York accounts for roughly 1 in 12 flagged providers nationally. The home care industry is the primary driver — Brooklyn alone has more flags than most states.
Arizona New-Entrant Cluster
Arizona's 46 new providers that appeared in 2022+ represent a distinct pattern from other states — suggesting systemic gaps in provider enrollment screening.
Small State Surprises
Vermont (1.08/100K), DC (1.03), and Maine (1.00) lead per-capita rates. Small populations mean a few flagged providers create outsized per-capita numbers. See our geographic analysis.
COVID Amplification
Every state saw billing increases during 2020-2023. But some — particularly Illinois and Virginia — saw specific providers with extraordinary growth that hasn't reverted.
Explore Your State
See flagged providers, top procedures, and spending trends for any state.
Browse All States →Related Guides
How Medicaid Fraud Works
Common schemes, red flags, and how data analysis can detect them.
Top Medicaid Billing Codes
The highest-spending HCPCS codes explained in plain English with fraud risk levels.
Understanding HCPCS Codes
What billing codes mean, how they're structured, and which ones are most associated with fraud.
How to Read a Medicaid Billing Record
Understand NPIs, claims, beneficiaries, and what the numbers mean on provider profiles.