America's Medicaid Fraud Capitals: City-Level Analysis
Brooklyn, NY leads the nation with 64 flagged providers and $13.69B in suspicious spending. New York City boroughs account for 121 flagged providers combined. Arizona cities add 77 more. And Nashville, TN is a surprise entry — just 13 flagged providers, but $11.15B in spending, the highest per-provider total of any city.
64
#1 City (Brooklyn)
121
NYC Total Flags
77
Arizona Cities
$857.8M
Nashville Per Provider
State-level analysis can obscure where fraud signals really cluster. When we drill down to the city level, a striking pattern emerges: a handful of cities account for a disproportionate share of flagged providers. The top 5 cities alone — Brooklyn, Phoenix, New York (Manhattan), Las Vegas, and the Bronx — account for 172 of the 414 flagged providers across all 32 cities in our dataset.
The Brooklyn Effect
Brooklyn alone has 64 flagged providers billing a combined $13.69B. This is driven largely by the home care industry — dozens of agencies billing hundreds of millions each for personal care services under code T1019. When you add Manhattan (30), the Bronx (17), and Flushing (10), NYC boroughs total 121 flagged providers and $27.98B in spending.
Arizona's fraud problem is equally concentrated. Phoenix leads with 43 flagged providers, followed by Mesa (16), Tucson (12), and Scottsdale (6). Combined, Arizona cities account for 77 flagged providers and $6.55B in suspicious spending — driven by an influx of new behavioral health clinics that appeared after 2022.
Nashville: The Per-Provider Outlier
Nashville, TN is one of the most surprising entries on this list. With only 13 flagged providers, it wouldn't stand out by count alone. But those providers billed a combined $11.15B — an average of $857.8M per provider. That's the highest per-provider spending of any city in the dataset, suggesting a small number of very large organizations driving the total.
Other notable clusters include Las Vegas (18 flags), which has emerged as a hotspot for billing anomalies in Nevada, and Los Angeles (12 flags, $7.99B in spending), which despite being the second-largest US city has fewer flags than Brooklyn alone. Texas contributes 36 flags across four cities (San Antonio, Houston, Fort Worth, Dallas), while the DC–Baltimore corridor adds 19 combined.
Top 15 Cities by Flagged Provider Count
Providers flagged for statistical billing anomalies across all detection methods.
All 32 Cities with Flagged Providers
| # | City | State | Flagged | Total Spending | Avg Per Provider |
|---|---|---|---|---|---|
| 1 | Brooklyn | New York | 64 | $13.69B | $213.9M |
| 2 | Phoenix | Arizona | 43 | $3.36B | $78.1M |
| 3 | New York | New York | 30 | $9.98B | $332.6M |
| 4 | Las Vegas | Nevada | 18 | $906.8M | $50.4M |
| 5 | Bronx | New York | 17 | $3.79B | $222.7M |
| 6 | Mesa | Arizona | 16 | $1.76B | $110.0M |
| 7 | Nashville | Tennessee | 13 | $11.15B | $857.8M |
| 8 | Tucson | Arizona | 12 | $1.23B | $102.7M |
| 9 | San Antonio | Texas | 12 | $2.60B | $217.0M |
| 10 | Los Angeles | California | 12 | $7.99B | $665.4M |
| 11 | Washington | District of Columbia | 10 | $1.34B | $134.4M |
| 12 | Houston | Texas | 10 | $1.76B | $175.7M |
| 13 | Boston | Massachusetts | 10 | $4.28B | $427.7M |
| 14 | San Diego | California | 10 | $1.58B | $158.3M |
| 15 | Philadelphia | Pennsylvania | 10 | $1.20B | $120.0M |
| 16 | Flushing | New York | 10 | $524.1M | $52.4M |
| 17 | Columbus | Ohio | 10 | $1.77B | $177.5M |
| 18 | Baltimore | Maryland | 9 | $478.5M | $53.2M |
| 19 | Albuquerque | New Mexico | 9 | $1.95B | $216.6M |
| 20 | San Jose | California | 8 | $2.46B | $307.9M |
| 21 | Kansas City | Missouri | 8 | $764.7M | $95.6M |
| 22 | Rochester | New York | 8 | $1.73B | $216.2M |
| 23 | Pittsburgh | Pennsylvania | 8 | $1.11B | $139.0M |
| 24 | Fort Worth | Texas | 7 | $1.77B | $252.7M |
| 25 | Louisville | Kentucky | 7 | $1.84B | $263.4M |
| 26 | Dallas | Texas | 7 | $1.30B | $185.1M |
| 27 | Charlotte | North Carolina | 6 | $126.5M | $21.1M |
| 28 | Orlando | Florida | 6 | $803.3M | $133.9M |
| 29 | Montgomery | Alabama | 6 | $3.08B | $513.4M |
| 30 | Scottsdale | Arizona | 6 | $202.4M | $33.7M |
| 31 | Colorado Springs | Colorado | 6 | $508.1M | $84.7M |
| 32 | Cleveland | Ohio | 6 | $1.77B | $294.5M |
Important caveat: Medical center bias
Cities with major medical centers, teaching hospitals, and large healthcare systems naturally have more providers and therefore more potential flags. A city like Nashville — home to HCA Healthcare and numerous hospital systems — will have high-volume billers that may trigger statistical anomaly detection without necessarily indicating fraud. These rankings identify where billing anomalies concentrate geographically, not where fraud is confirmed.
Key Takeaways
- ▸Brooklyn leads the nation with 64 flagged providers and $13.69B in spending, driven by the home care industry.
- ▸NYC boroughs combined (121 flags) account for more flagged providers than any single state except New York itself.
- ▸Arizona cities (77 flags) represent the second-largest geographic cluster, fueled by new behavioral health clinics post-2022.
- ▸Nashville ($857.8M/provider) has the highest per-provider spending of any city — a small number of very large billers driving $11.15B total.
Source: HHS Medicaid Provider Spending Data (2018–2024) · 227M records