We analyzed a decade of CMS physician payment data — every line item, every provider, every dollar. The result: 500 providers with billing patterns that don't add up. This isn't about accusations. It's about transparency.
How we go from raw CMS data to actionable fraud flags
⚠️ Important Context
All data on this page comes from publicly available CMS Medicare payment records. Unusual billing patterns may reflect legitimate medical practices (such as high-volume drug administration where each unit is counted as a separate service), data reporting differences, or group practice billing. Inclusion on this page does not constitute an accusation of fraud or wrongdoing. Only law enforcement and regulatory agencies can determine whether billing patterns represent fraud. Providers flagged by our statistical model have billing patterns similar to previously convicted providers, but many may have perfectly legitimate explanations.
Eight angles on Medicare fraud — from AI detection to wound care schemes
500 providers flagged for billing anomalies — separated by individuals vs organizations, with inline flag details and color-coded risk scores.
ExploreDetailed fraud profiles for the top 20 highest-risk individual providers. Payment breakdowns, flag explanations, and fraud feature analysis.
ExploreThe 100 Medicare providers with the highest AI-predicted fraud probability, ranked by our ML model trained on 2,198 confirmed fraudsters.
ExploreOur ML model scored 1.7M providers against 2,198 confirmed fraudsters. 500 scored above 86% match. AUC: 0.83.
Explore$2.8B billed for COVID tests via HCPCS K1034. Who billed millions for questionable COVID tests during the pandemic?
Explore$5.5B in wound care billing. The DOJ's largest-ever healthcare fraud takedown targeted skin substitute schemes.
Explore53.2% of E&M visits billed as 99214 nationally. Office visit codes 99213 vs 99214 account for $117.7B in Medicare spending.
Explore4.6K providers flagged with physically impossible billing volumes. The worst: 9,862 services per working day.
ExploreInteractive geographic visualization of Medicare fraud hotspots. See where flagged providers cluster across the country.
ExploreHow to report Medicare fraud to the OIG, including the False Claims Act whistleblower program (15-30% of recovered funds).
ExploreDisclaimer: These are statistical flags based on publicly available CMS data, not accusations of fraud. Billing anomalies can have legitimate explanations. If you suspect fraud, report it to the OIG Fraud Hotline: 1-800-HHS-TIPS (1-800-447-8477).
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Last Updated: February 2026
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.