The Rise of Corporate Medicine

Published February 2026 · 13 min read

When Americans think of Medicare billing, they picture doctors and hospitals. But the reality is that some of the biggest recipients of Medicare payments are corporations — clinical laboratories, ambulance companies, diagnostic testing facilities, and ambulatory surgical centers that process millions of claims annually.

Our analysis of the top 1,000 Medicare billers reveals that organizations not only outnumber individuals on the list but also collect significantly more per entity. The era of the independent physician-as-primary-biller is being eclipsed by corporate medicine.

Organizations vs. Individuals: The Numbers

The organizational dominance is even more pronounced at the very top. Of the 20 highest-billing entities in Medicare, the vast majority are organizations — with clinical laboratories occupying most of the top spots. The single highest-billing entity, LabCorp's North Carolina operation, received $2.2B over the analysis period.

The Lab Corporation Duopoly

Two companies dominate Medicare laboratory billing: Laboratory Corporation of America (LabCorp) and Quest Diagnostics. Together, their various state-level entities collected over $7.4B from Medicare.

LabCorp appears multiple times in the top billers list because CMS tracks billing by NPI (National Provider Identifier), and large corporations have separate NPIs for different state operations. When consolidated:

These two companies effectively form a duopoly in Medicare lab testing. They process hundreds of millions of tests annually — blood panels, genetic tests, cancer screenings, drug tests — and their scale means that even at Medicare's relatively low per-test reimbursement rates, the total payments are enormous.

Beyond Labs: The Corporate Ecosystem

While clinical laboratories dominate, other corporate sectors are also heavily represented among top Medicare billers:

The Consolidation Trend

The dominance of organizations in Medicare billing reflects a broader trend in American healthcare: consolidation. Over the past decade, the number of independent physician practices has declined sharply, while hospital-owned practices, private equity-backed groups, and corporate chains have expanded.

Medicare's total provider count grew from 938.1K in 2014 to1.2M in 2023 — a 25% increase. But much of this growth came from organizational NPIs, as corporate entities expanded their footprints. The average provider received $79.7K per year in 2023, but organizational billing entities at the top received thousands of times more.

The Private Equity Factor

Private equity investment in healthcare has surged in recent years, with firms acquiring physician practices, urgent care chains, and specialty clinics. While the Medicare data doesn't directly identify PE-backed entities, the pattern is visible: organizations with generic names, multi-state operations, and high billing volumes often have private equity ownership behind the scenes.

The concern is that corporate ownership may prioritize billing optimization over patient care — scheduling more procedures, upcoding visits, and maximizing revenue per encounter. The data alone can't prove this, but the trend toward organizational dominance in Medicare billing is unmistakable.

Why This Matters

The corporatization of Medicare billing has profound implications:

• Market power: When two lab companies dominate testing, they have outsized influence over what tests are ordered and how they're priced.
• Oversight challenges: Corporate structures with multiple NPIs across states make it harder for regulators to see the full picture of any single entity's Medicare revenue.
• Access implications: Corporate consolidation in ambulance services, for example, can affect emergency response times and service quality, particularly in rural areas.
• Cost pressure: While organizations achieve economies of scale, the savings don't always flow back to Medicare — they may instead flow to shareholders.

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