The COVID Gold Rush: How $2.8B in Test Billing Changed Medicare Forever

Published February 2026 · 14 min read

The Pandemic Created a New Industry Overnight

When COVID-19 swept the nation, the federal government did something unprecedented: it told Medicare to pay for COVID tests with almost no questions asked. Emergency waivers removed prior authorization requirements. Telehealth rules were relaxed. New billing codes were fast-tracked.

The result was predictable. A massive new revenue stream appeared overnight, and entrepreneurs — some legitimate, many questionable — rushed to tap it. Pop-up testing sites appeared in strip malls. Pharmacies pivoted to testing. Clinical laboratories multiplied like mushrooms after rain.

Our analysis of CMS Medicare Part B data reveals the full picture of where that money went — and the patterns are striking.

The Numbers: Year by Year

The jump from $1.1B in 2022 to $1.8B in 2023 — a 69.0% increase — tells a clear story. Even as the acute pandemic phase waned, COVID test billing surged. More providers entered the market. More services were billed. The gold rush was accelerating, not slowing down.

Follow the Money: The State Breakdown

COVID test billing wasn't evenly distributed across America. It concentrated heavily in a few states — and the leader may surprise you.

Illinois dominates. With $705.2M in COVID test payments — 24.9% of the national total — Illinois received more than Florida and Texas combined. That's 1,242 providers billing for 6.8M beneficiaries.

Florida came in second at $392.9M, followed by Texas at $339.8M and California at $220.9M.

The Illinois concentration is particularly notable because the state doesn't have the largest Medicare population. What it does have is a cluster of clinical laboratories in and around Chicago that became testing powerhouses.

The Top Billers: Who Profited Most?

The top 20 COVID test billers in Medicare tell a remarkable story. A single provider — Vra Enterprises, Llc in Tampa, FL — billed $75.8M for 6.4M services to 540.9K beneficiaries.

That's $140.20 per beneficiary — far above the national average.

The Chicago Lab Cluster

Zoom in on the top billers and a pattern jumps out: Chicago-area clinical laboratories dominate the list. Among the top 20, 4 are based in Chicago itself. Names like Vcare Testing Centre Corp, Chicago Care Lab Services, and S K Diagnostics — entities that billed tens of millions each.

Several of these labs share characteristics common to known COVID testing fraud schemes: they were newly formed, they billed enormous volumes, and they served suspiciously large numbers of beneficiaries relative to their size.

The top 5 providers alone — all from Florida, Illinois, and Georgia — accounted for over $305.3M in Medicare payments. To put that in perspective, that's more than many states received in total.

The Florida Connection

Florida's role in the COVID gold rush deserves special attention. With 3,064 providers billing for COVID tests — the most of any state — Florida was the epicenter of provider proliferation. While Illinois had higher total payments with fewer providers, Florida's 3,064 providers suggest a wider, more distributed billing pattern.

The top Florida biller, Vra Enterprises, Llc, a Pharmacy in Tampa, billed $75.8M — notable because pharmacies don't traditionally perform the volume of laboratory testing implied by 6.4M services.

What the Data Reveals

Several patterns emerge from our analysis:

The Bigger Picture

The COVID testing gold rush didn't happen in a vacuum. It's part of a larger story about how Medicare's fee-for-service system responds to emergencies. When normal oversight mechanisms are relaxed — even for good reasons — the system becomes vulnerable to exploitation.

The Department of Justice has already brought dozens of fraud cases related to COVID testing. But the data suggests the problem is far larger than what's been prosecuted. Many of the billing patterns we see in the data match profiles of known fraud — but involve providers that haven't been charged.

Explore the full trend data yourself, or dive into specific states like Florida and California to see the patterns in your area.

Methodology

This analysis uses Medicare Part B Public Use Files from CMS, filtered to HCPCS codes associated with COVID-19 testing (including U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, and related codes). All payment figures reflect actual Medicare payments, not billed charges. Provider counts reflect unique NPIs billing at least one COVID-related service in a given year.