59 data-driven investigations on Medicare spending patterns, healthcare fraud, and transparency. Our team analyzes billions in Medicare payments to uncover stories that matter.
Our AI systems are finding fraud patterns that traditional auditing misses — and the implications for Medicare oversight are staggering.
Machine learning models trained on Medicare billing data can detect fraud patterns invisible to human auditors. Our latest AI analysis reveals how algorithmic detection is reshaping healthcare oversight.
We flagged 500 providers. The DOJ charged 324 people in $14.6B of fraud. Multiple of our top-flagged providers were among them.
Our fraud detection algorithm — built entirely from public Medicare data — flagged the same providers that federal investigators spent years pursuing. At least 6 of our flagged providers were subsequently charged by the DOJ, including the entire Arizona wound care ring.
$514 million billed by 23 nurse practitioners for just 2,974 patients — with identical 1.28x markup ratios
23 nurse practitioners in the Phoenix metro area billed Medicare $514.3 million for skin substitute products. Only 2,974 patients. Top biller: $1.5 million per patient. All share a nearly identical 1.28x markup ratio — suggesting coordinated billing.
Cosmetic surgeons marketing facelifts — but billing Medicare $45.6 million in wound care
3 Beverly Hills plastic surgeons and 1 physician assistant billed Medicare $45.6 million — with 83-95% of billing in wound care, not cosmetic surgery. One co-founded the "Wound Institutes of America."
Our AI trained on 8,300+ confirmed fraudsters found providers with identical billing patterns still collecting from Medicare.
We trained a machine learning model on every confirmed Medicare fraudster — DOJ indictments, HHS OIG exclusions, FCA settlements. Then we ran it on 1.7 million active providers. The results were sobering.
Keith J. Gray was convicted Thursday for a $328M genetic testing fraud scheme. But his case is just one symptom — genetic testing has become one of Medicare's most exploited billing categories.
Over 10 years, providers submitted $3.22 trillion in charges to Medicare. Medicare paid $854.8 billion. The other $2.14 trillion — 66.3% — was written off. This is the biggest hidden number in healthcare.
Madhavi Rayapudi, an infectious disease specialist in Georgia, billed Medicare for 2,465,495 services in a single year. That's 9,862 per working day. The math doesn't add up.
Houston leads the nation with $9.24 billion in Medicare spending across 19,925 providers. The Texas Medical Center effect makes the Bayou City America's healthcare billing capital.
A deep dive into Medicare's top-earning providers reveals patterns in specialty care, geographic concentration, and billing practices that raise questions about healthcare resource allocation.
Medicare Part B drug spending has exploded over the past decade, with oncology and rheumatology driving unprecedented growth in physician-administered drug costs.
The COVID-19 pandemic dramatically altered Medicare spending, with telehealth surging and elective procedures plummeting. Our analysis reveals the lasting impacts on healthcare delivery.
Rural healthcare providers receive higher Medicare reimbursements, but patients still face access challenges. We examine the geography of Medicare payments and healthcare equity.
Primary care physicians earn a fraction of what specialists make from Medicare, creating incentives that may distort healthcare delivery and access to basic services.
Anesthesia services consistently show some of the highest charge-to-payment ratios in Medicare. We investigate the providers and practices behind the markup.
Who receives the most Medicare money? Our analysis reveals the organizations and individuals at the top of Medicare's payment hierarchy.
Medicare spending per beneficiary varies by more than 2x across states. We map the divide and explore what drives regional differences in healthcare costs.
The rise of corporate healthcare entities has reshaped Medicare spending. We trace the growth of organizational billing and what it means for patients.
Evaluation and management codes account for the largest share of Medicare spending. We break down the economics of the humble office visit.
After the COVID-19 crash, Medicare spending recovered — but the landscape shifted. Telehealth persisted, some specialties boomed, and others never fully recovered.
Eye care is one of Medicare's largest spending categories. We investigate the procedures, providers, and drug costs driving billions in ophthalmology payments.
For every dollar Medicare spends, where does it actually go? We trace the flow of Medicare payments across specialties, procedures, and geographies.
K1034 was created for COVID OTC tests at ~$12 each. Some providers billed millions. Merry Taheri, a single nurse practitioner in Torrance, CA, billed $12.1M — 990x the specialty median.
HHS-OIG calls skin substitutes "particularly vulnerable to fraud." The DOJ's $14.6B takedown targeted wound care. We follow the money from Beverly Hills to the DOJ.
Individual providers billing 400+ services per day — a new patient every 72 seconds for 8 hours straight. Either these are the fastest doctors in America, or something else is going on.
The average family doctor earns $55K from Medicare. These providers bill $10M+. Inside the millionaire club: 1,000 providers who collected billions from Medicare over the past decade.
Just 5 specialties account for 33% of all Medicare spending. Clinical labs earn $1.9M per provider while nurse practitioners average $26K. The specialty you choose determines your Medicare income.
Medicare spending grew from $78B to $94B in 10 years. COVID crashed it 10% in 2020, then it rebounded past pre-pandemic levels. At this rate, we're heading toward $110B+ by 2030.
Medicare pays $121K per provider in Florida but $18K in Puerto Rico. Urban providers earn $20K more than rural ones. Miami-Dade is the Medicare fraud capital of America.
One eye injection drug — aflibercept — has cost Medicare $19.7 billion. Drug spending's share nearly doubled from 8% to 15%. The pharmaceutical pipeline keeps growing.
2025 was the biggest year for Medicare fraud enforcement in history. The DOJ charged 324 defendants in a $14.6 billion takedown while False Claims Act recoveries hit a record $6.8 billion.
The range is enormous: from $26K for nurse practitioners to $384K for ophthalmologists. We break down the fee schedule, markup ratios, and how Medicare compares to private insurance.
Search by name or NPI, understand payment data, read provider profiles, and learn what fraud flags mean. A complete guide to using OpenMedicare's provider lookup tool.
Office visits dominate by volume at $73B, but drug injections cost thousands per service. Aflibercept, chemotherapy, and cardiac procedures lead per-unit costs.
California leads total spending at $93B, but Florida leads per-provider at $121K. The gap between highest and lowest per-provider spending is more than 7x.
LabCorp and Quest Diagnostics operate 37 NPIs across the country, billing Medicare $14 billion over 10 years. Together they handle 25% of all clinical laboratory billing. Is this efficiency or monopoly?
COVID forced CMS to allow telehealth billing overnight. Medicare spending crashed 10% in 2020 then rebounded past pre-pandemic levels. Telehealth is here to stay — but is it saving money or enabling fraud?
Nurse practitioners are 11.4% of all Medicare providers but average just $26K in payments. Some NPs bill millions. The scope of practice debate meets Medicare data.
Nurse practitioners are Medicare's fastest-growing provider type — and emerging as a new fraud vector. Our AI model flagged NPs billing $1.6M+ while matching convicted fraudster patterns. The oversight gap is real.
Pain management is a known fraud vector tied to the opioid crisis. Our AI model flagged 7 pain management providers billing up to $3M each — including one with 64,000 services.
24 oncologists with >80% drug billing and >$5M each — $171M combined. Oncology has the most impossible-volume providers of any specialty: 532 out of ~1,100. The ASP+6% formula incentivizes expensive drugs.
Florida has 185 individual providers billing 400+ services per day — 17% of the national total from one state. From Fort Walton Beach to The Villages, small cities harbor impossible billing volumes.
Beverly Hills providers bill Medicare at rates far exceeding the national average. Plastic surgeons billing wound care, ambulatory surgery centers, and the luxury ZIP code effect.
Providers submit charges that average 2.4x what Medicare actually pays. The gap between submitted and paid amounts reveals a hidden $100 billion markup built into the system.
An expanded deep-dive into how Medicare compensation varies across specialties — from nurse practitioners averaging $26K to ophthalmologists at $384K.
A nurse practitioner billing $12.1M in COVID tests. A Beverly Hills plastic surgeon billing $28.9M in wound care. An anti-aging spa doctor with a 197.7x markup. Three providers, three statistical anomalies.
A technical deep-dive into building a supervised Random Forest model trained on 96M rows of Medicare billing data and 8,300+ confirmed fraud labels from LEIE/DOJ. AUC 0.83, feature engineering, and lessons learned.
263 of 500 AI-flagged providers (53%) are Internal Medicine specialists. High-volume billing, broad procedure codes, and easy-to-pad office visits make IM the #1 specialty for fraud-pattern matches.
California and Florida each have 56 AI-flagged Medicare providers — 22.4% of all flags. Combined with NY, TX, and NJ, five states account for over half of all suspicious billing patterns.
47 providers flagged by our AI model each billed Medicare over $1 million. Combined, they collected over $93 million in taxpayer money — while matching the billing patterns of convicted fraudsters.
56 California providers flagged by our AI fraud detection model billed Medicare $47 million. From Los Angeles clinics to Bay Area labs, these providers match the billing patterns of previously convicted fraudsters.
Florida has long been America's Medicare fraud capital. Our AI model flagged 56 providers billing $52 million in suspicious patterns — from Miami's notorious medical corridors to Tampa Bay clinics.
39 New York providers were flagged by our AI fraud detection model for billing patterns that match convicted fraudsters. From Brooklyn clinics to Manhattan specialists, these providers warrant closer scrutiny.
Select a specialty to see real payment data from 10 years of Medicare records. Interactive explorer of Medicare payments by specialty.
From $854.8 billion in total spending to 1.7 million providers, the essential statistics that define Medicare Part B over the last decade.
A decade of Medicare Part B data reveals a system that grew 20% — from $78B to $94B — while surviving a pandemic, absorbing 230,000 new providers, and delivering 400 million more services annually.
4,636 Medicare providers billed more than 100 services per working day — led by Madhavi Rayapudi at 9,862 services/day. Most are drug unit billing, not necessarily fraud, but the numbers demand scrutiny.
When the pandemic hit, COVID testing became the biggest gold rush in Medicare history. We tracked every dollar — $2.8 billion across 246 million services.
We trained a machine learning model on 2,198 confirmed fraud cases. It scored 1.7 million providers. Here's what it looks for — and what it found.
New investigations published regularly. 64 articles and counting.
Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.