Medicare's Millionaire Club: The 1% Who Bill the Most

Published February 2026 · 14 min read

The Scale of Concentration

Medicare pays over a million providers every year. But the distribution is wildly uneven. Our database of the top 1,000 providers — all of whom received at least $1 million — reveals an extraordinary concentration of payments at the top.

Individual vs. Organization

Of the top 1,000 Medicare providers, 545 are organizations (laboratories, ambulance companies, surgical centers) and 455 are individual practitioners. Organizations dominate the top of the list — the biggest being Laboratory Corporation of America with over $2.2 billion in cumulative Medicare payments.

But among individuals, the numbers are still staggering. Individual providers in this dataset have each collected millions — sometimes tens of millions — from Medicare over the past decade.

Which Specialties Dominate?

The millionaire club isn't evenly distributed across medicine. A handful of specialties account for the vast majority of these high-billing providers:

Clinical laboratories and ambulance services lead the pack — not because of fraud, but because of sheer volume. A single national lab processes millions of tests per year. But ophthalmology's presence is notable: eye care specialists earn their way into the millionaire club through expensive injectable drugs like aflibercept, which alone accounts for $19.7 billion in Medicare spending.

Top 20 Individual Providers

These are the highest-billing individual providers in the Medicare system — not organizations, but single practitioners. Note: some names may appear as “Unknown” due to CMS privacy thresholds.

What Does This Mean?

High Medicare payments don't automatically indicate fraud or waste. Large laboratories serve millions of patients. Ophthalmologists administer expensive drugs that Medicare sets the price for. Ambulance services operate across entire states.

But the concentration raises important questions: When a handful of providers collect billions, is Medicare getting value for its money? Are there competitive markets, or do dominant players set the terms? And when an individual practitioner bills $100M+ over a decade, what oversight exists to ensure those services were actually delivered?

The millionaire club is a feature of how American healthcare works — massive volume, expensive drugs, and a payment system that rewards throughput over outcomes. Understanding who's in the club is the first step toward understanding whether the system is working.