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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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© 2026 OpenMedicare. Independent data journalism. Built by TheDataProject.ai

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⚠️ 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.

The 20 Most Suspicious Medicare Providers in America

We analyzed 1.72 million Medicare providers across a decade of billing data. These 20 individuals have the most extreme statistical anomalies — billing patterns that, in our experience, almost always indicate fraud.

What you're about to see:

  • • A nurse practitioner billing 4,132 services per day — one every 7 seconds
  • • A doctor with a 197.7x markup ratio — charging $19,770 for every $100 Medicare pays
  • • A hematologist upcoding at 476 times the expected rate
  • • A provider claiming 564 unique patients per day — more than most hospitals

Every dollar shown is real CMS data. Every name is from public Medicare records.

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🤖 See Also: AI-Powered Analysis

Our machine learning model scored 1.72M providers using patterns from 2,198 convicted fraudsters. It flagged 500 with 86%+ match probability.

500 AI-Flagged Providers →The Full Investigation →

Related Fraud Analysis

🚨 Enhanced Watchlist — Full 500-provider list🩹 Wound Care — DOJ's #1 fraud target🦠 COVID Test Billing — Pandemic profiteers🧮 Impossible Numbers — 4,636 flagged providers⬆️ Upcoding — Billing for services never provided🔍 Three Providers, Three Red Flags📊 How we analyze the data →

Disclaimer: 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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Data Sources

  • • CMS Medicare Provider Utilization and Payment Data (2014-2023)
  • • HHS Office of Inspector General

Last Updated: February 2026

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.