Insights
Deep-dive investigations into $1.09 trillion in Medicaid spending. Each story is built from 227 million billing records released by HHS.
Featured Investigations
Deep-dive reporting into the most striking patterns in the data.
The 2026 Medicaid Fraud Crackdown: DOGE, CMS, and $37B in Waste
CMS is withholding payments from states, DOGE is pushing AI fraud detection, and California just busted a massive hospice scheme. The most aggressive Medicaid fraud crackdown in years.
The One Big Beautiful Bill: What $880B in Medicaid Cuts Actually Mean
Work requirements, FMAP reductions, and eligibility redeterminations every 6 months. We analyzed the bill against 227M billing records to show what the biggest Medicaid restructuring in decades means in practice.
The $14.6 Billion Healthcare Fraud Takedown
324 defendants. $14.6 billion in intended losses. The largest healthcare fraud enforcement action in history — and why reactive enforcement alone cannot solve the problem.
DOGE vs. Medicaid: What $1.09 Trillion in Billing Data Actually Shows
Elon Musk's DOGE released Medicaid spending data for the public to find fraud. We already analyzed all 227M records. Here's what $1.09T in billing data reveals about fraud, waste, and proposed $880B in cuts.
Minnesota: America's Medicaid Fraud Capital
Minnesota has 4x its population share of fraud-heavy exclusions. 81% of all interpreter fraud in the country is in one state. How generous programs with weak oversight became a magnet for organized fraud.
$37.4 Billion in Improper Payments: Medicaid's Growing Error Rate
FY2025 improper payments hit $37.39 billion — a 6.12% error rate, up from 5.09%. Most is paperwork errors, not fraud. But the system keeps getting worse, not better.
The Arizona Problem: New Clinics, Massive Billing
46 new Arizona providers appeared in 2022+ and immediately billed over $800M combined. Many operated for less than a year. Phoenix dominates.
The New York Home Care Machine
New York dominates Medicaid personal care spending. Brooklyn alone has dozens of agencies billing $200M+ each. The top 100 T1019 billers: $47B+.
Who Made the Most Money During COVID?
The City of Chicago went from $23M to $240M — a 942% increase. What were they billing for?
The Hidden Billing Networks of Medicaid
65% of all claims have a different billing NPI than servicing NPI. Cleveland Clinic bills for 5,745 providers. 174,774 'ghost billers' never provide services.
Impossible Billing Volume: 50+ Claims Per Day
200 providers file more than 50 claims per working day — some over 60,000. At that pace, each patient visit would last seconds.
When the Numbers Don't Add Up: Benford's Law Analysis
Benford's Law predicts leading digit distribution in natural data. We tested 617K providers' claim amounts — 200 show statistically significant deviations.
Billing Behavior Shifts: When Providers Suddenly Change
CUSUM change point detection found 170 providers whose monthly billing shifted 3x+ overnight. The biggest jump: 113x — from $96K/month to $10.9M/month.
Multi-Method Detection: Providers Flagged by Multiple Systems
These providers were flagged by 2+ independent detection methods — statistical tests, Benford's Law, billing velocity, and change point detection. When multiple approaches agree, false positive probability drops dramatically.
Geographic Risk Hotspots: Where Fraud Signals Concentrate
Some states have disproportionately more fraud signals per resident. Vermont (1.08 per 100K), DC (1.03), and Maine (1.00) lead per capita. Arizona is notable given our separate investigation.
Round Number Billing: When Every Claim Ends in Zeros
100 providers submit heavy round-number claims — nearly 68,000 at exact dollar amounts like $500, $1,000, $2,500 — totaling $128M. Legitimate billing rarely produces round numbers.
America's Medicaid Fraud Capitals: City-Level Analysis
Brooklyn NY leads with 64 flagged providers and $13.7B in spending. NYC boroughs total 111 flags. Nashville averages $858M per flagged provider — the highest of any city.
Spending Deep Dives
Where does $1.09 trillion actually go? Follow the money through specific codes and categories.
Medicaid Spending by State: Who Gets the Most Federal Dollars?
New York receives $81.1B — more than California and Massachusetts combined. The top 5 states account for over half of all Medicaid spending. Full state-by-state breakdown.
From $109B to $199B: How Medicaid Spending Nearly Doubled in 6 Years
Medicaid spending grew 83% from 2018 to 2023. COVID was the turning point — 2021 added $30.5B in a single year. Provider counts grew from 324K to 360K. 2024 partial data suggests another record.
Who Got Paid the Most to Give COVID Vaccines?
Tribal hospitals dominate the top of the list. Shiprock Hospital in New Mexico billed $11.8M alone.
The $4.7 Billion COVID Testing Bonanza
A single test code billed $3.9 billion. One New Jersey lab — Infinity Diagnostics — billed $129M.
The Most Expensive Things Medicaid Pays For
One procedure costs $92,158 per claim. It's a drug for spinal muscular atrophy.
Inside Medicaid's Most Expensive Drugs
50 provider-administered J-codes billed through Medicaid. The most expensive costs $92,158 per claim. Many are billed by just 1–3 providers nationwide.
The Procedures Growing Fastest in Medicaid
One code grew 8,935% in five years. ABA therapy for autism grew 1,500%+, connecting to Minnesota fraud.
Provider Analysis
Who bills, how much, and what patterns emerge across 617,000+ providers.
The Highest-Paid Individual Medicaid Providers
Only 2 individual people — not organizations — appear in the top 2,000 billers. One is a psychologist in Wisconsin.
Who Bills for the Most Patients?
Some providers serve over 100 million beneficiaries. Transportation brokers and managed care orgs dominate. Individual doctors typically see hundreds.
The Providers Who Bill Exactly the Same Amount Every Month
14 providers billing $100K+/month maintain less than 5% variation for years. Normal practices vary 15-40%. These are under 5%.
Where Does $1 Trillion in Medicaid Money Actually Go?
264 home health providers received $71B. Just 15 'Supports Brokerage' providers got $10.8B — averaging $720M each.
The Dual-Billing Pattern: When Claim Counts Match Too Perfectly
Mass DDS bills T2016 and T2023 with 82,639 vs 82,963 claims — 0.4% difference, $958M total. This pattern appears in confirmed fraud cases.
Solo Operators: Providers Billing $5M+ Entirely Themselves
100 providers bill $5M+ where 95%+ of payments go to self-billed claims — billing and servicing NPI are the same. Together they account for over $72B.
Most Suspicious Providers
The most concerning cases from our unified risk system. These providers triggered 3 or more independent anomaly flags, or scored extremely high on our ML fraud detection model.
SRH CHN Lead Health Home LLC
CRITICALNew York (NY) · NPI: 1750053948 · Case Management
$239.0M
total spending
Appeared in 2022 and already billed $239.0M — one of the fastest-growing new entrants in the dataset. Spending changed by 209% between 2022–2023, an unusual swing of $72.5M.
City of Chicago
CRITICALIllinois (IL) · NPI: 1376554592 · Ambulance
$1.23B
total spending
Spending changed by 706% between 2019–2020, an unusual swing of $162.6M. Bills 12.6× the national median for A0429 (Ambulance, BLS emergency transport).
Community Assistance Resources & Extended Services INC
CRITICALNew York (NY) · NPI: 1396049987 · Case Management
$1.04B
total spending
Spending changed by 6886% between 2020–2021, an unusual swing of $111.0M. Bills 4.5× the national median for H2014 (Skills training & development, per 15 min).
Montefiore Medical Center
CRITICALNew York (NY) · NPI: 1952476988 · General Acute Care Hospital
$961.1M
total spending
Spending changed by 209% between 2018–2019, an unusual swing of $50.4M. Bills 3.1× the national median for 99214 (Office/outpatient visit, est. patient, mod-high complexity).
Sun River Health Inc.
CRITICALNew York (NY) · NPI: 1619969458 · Clinic/Center Federally Qualified Health Center (FQHC)
$546.5M
total spending
Spending changed by 274% between 2018–2019, an unusual swing of $56.4M. Bills 4.5× the national median for 90832 (Psychotherapy, 30 minutes).
The New York and Presbyterian Hospital
CRITICALNew York (NY) · NPI: 1194832477 · General Acute Care Hospital
$454.9M
total spending
Spending changed by 217% between 2018–2019, an unusual swing of $22.3M. Bills 5× the national median for 99213 (Office/outpatient visit, est. patient, low-mod complexity).
Coordinated Behavioral Care INC
CRITICALNew York (NY) · NPI: 1730451071 · Case Management
$407.2M
total spending
Spending changed by 1443% between 2018–2019, an unusual swing of $18.4M. Bills 6.5× the national median for G9005 (Coordinated care fee, risk-adjusted, ESRD).
The Collaborative for Children and Families
CRITICALNew York (NY) · NPI: 1417349622 · Case Manager/Care Coordinator
$347.3M
total spending
Spending changed by 245% between 2019–2020, an unusual swing of $22.3M. Bills 3.1× the national median for T2022 (Case management, per month).
Small Provider Fraud Spotlight
Fraud isn't just about big billers. Our ML model identified small providers whose billing patterns closely match confirmed fraud cases from the OIG exclusion list. These providers bill between $10K and $1M but score higher than many $100M+ organizations.
Ridgeline Recovery LLC
NPI: 1255099495
ML fraud risk score
Angel Minds Wellness & Behavioral Health Llc.
NPI: 1396387486
ML fraud risk score
Dove Recovery LLC
NPI: 1104513670
ML fraud risk score
Wecare Medical Transport, Llc
NPI: 1356052385
ML fraud risk score
Michael Fletcher
NPI: 1063476216
ML fraud risk score
About these scores: Our random forest model was trained on features from 594,234 providers and validated against the HHS-OIG exclusion list. A score above 85% means the provider's billing patterns are statistically similar to providers who were later excluded for fraud. This is not proof of fraud — it's a signal that warrants closer inspection.
Submit a Tip
Know something about a flagged provider? Have data we should look at? Get in touch.
kian@thedataproject.aiAll tips are confidential. Whistleblower protections exist under the False Claims Act.