ANALYZING THE LARGEST MEDICAID DATASET IN HISTORY

Tracking $90.9B in Suspected Improper Payments

Analyzing the DOGE HHS dataset — 227,000,000 rows of Medicaid provider spending from 2018–2024 — cross-referenced against the NPPES provider registry.

TOTAL SPENDING
$375B

2.1M providers nationwide

IMPROPER PAYMENTS
$0B

5.09% CMS improper payment rate

HIGH-RISK DETECTED
0

$5.6B in flagged spending

TOTAL SPENDING

$1785.0B

2018–2024 cumulative

PROVIDERS ANALYZED

2.1M

500 in sample

FLAGGED PROVIDERS

3247

$5.6B flagged

EST. IMPROPER PAYMENTS

$90.9B

5.09% CMS improper rate

GEOGRAPHIC RISK DISTRIBUTION

Avg risk 13.2 across 49 states

Low
Medium
Elevated
High
Critical

NATIONAL MONTHLY SPENDING

JAN 2018 — DEC 2024
PEAK

$25.9B

AVG

$20.4B

LOW

$14.1B

2018-012019-012020-012021-012022-012023-012024-01$0B$7B$13B$20B$26B

RISK BY SPECIALTY

Audiologist60
Anesthesiology, Pain Medicine30
Physician Assistant30
Family Medicine, Adult Medicine30
Pathology, Clinical Laboratory Director, Non-physician27
Internal Medicine, Sleep Medicine27
Obstetrics & Gynecology26
Psychiatry & Neurology, Child & Adolescent Psychiatry25
Nurse Anesthetist, Certified Registered25
Internal Medicine, Hepatology25

AVG RISK SCORE BY PROVIDER TAXONOMY

TOP PROCEDURES BY SPENDING

HCPCS — 2018–2024
T1019
Personal Care Services, per 15 minutes
$187.0B
99213
Office/Outpatient Visit, Established Patient, Low-Moderate Complexity
$98.5B
99214
Office/Outpatient Visit, Established Patient, Moderate-High Complexity
$112.0B
90834
Psychotherapy, 45 Minutes
$42.0B
T2003
Non-Emergency Transportation, Encounter/Trip
$38.5B
97110
Therapeutic Exercises, Each 15 Minutes
$35.2B
96372
Therapeutic/Prophylactic/Diagnostic Injection, Subcutaneous/IM
$28.7B
90837
Psychotherapy, 60 Minutes
$31.0B
S5125
Attendant Care Services, per 15 Minutes
$26.4B
H0015
Alcohol and/or Drug Services, Intensive Outpatient
$18.9B

HIGH-RISK PROVIDERS

46 RECORDS
RISK NPIPROVIDER STATE TOTAL PAID
100
1003460890BAY SHORE BRIGHTWATERS RESCUE AMBULANCE INC.NY$107.5M
100
1750442844ADVANCED REHABILITATION OF METAIRIELA$52.5M
100
1013951623SAMUEL FINEBERGAL$269.2M
100
18719308261 AFFINITY HEALTHCARE SERVICES INCTX$204.5M
100
1841727021RICHARD FERNANDES ALMEIDAWI$86.4M
85
1417704883NASER UDDINMD$137.2M
80
1215029269VICKI BAKERWV$213.6M
80
1184204711JAMES ABERCROMBIECO$217.1M
80
1699719336MARIA GOMESNC$278.8M
80
1669490348GORDON AHLERSVT$85.3M
80
1093715435JAMES EVANSONME$55.7M
80
1821321647BILLINGS CLINICMT$66.1M
75
1861400095ALEXANDER MALAYEV MD PCME$69.3M
75
1780382721ABBY PERSONAL CARE INC.WI$223.4M
70
1841794211LEILA ABAAB DRIRAMI$191.6M
70
1073170494AIDMEN MEDICAL EQUIPMENT LLCKY$253.1M
70
1700167830ALLISON ALLENAK$117.0M
70
1710416870NARSIS AMINIANDE$140.6M
70
1124738463MONOGRAM HEALTH PROFESSIONAL SERVICES OF SOUTH DAKOTA, PLLCSD$141.0M
70
1134573777AMANDA ADDINGTONTN$200.5M
70
1750502688ADVANCE PHYSCIAL THERAPY AND REHABILITATIONLA$279.8M
70
1851404396SUSAN ALGOODTN$222.2M
70
1851395610JACK BROCKNM$161.8M
70
1548823669KIRSTIN ACUSOH$52.5M
70
1437978236ACUTE BEHAVIORAL HEALTH OF VIRGINIA, P.C.TN$212.4M
1–25 of 46

DATA SOURCES

DOGE HHS Medicaid Provider Spending

PRIMARY

227M rows of provider-level spending data from T-MSIS (2018–2024)

opendata.hhs.gov/datasets/medicaid-provider-spending/

NPPES NPI Registry

CACHED

Provider identity verification — name, address, taxonomy, enumeration date

npiregistry.cms.hhs.gov/

OIG LEIE Exclusion List

CROSS-REF

Individuals/entities excluded from federal healthcare programs

oig.hhs.gov/exclusions/

CMS Open Payments

CROSS-REF

Financial relationships between providers and manufacturers

openpaymentsdata.cms.gov/

COMPOSITE RISK SCORING

Each provider receives a composite risk score (0–100) based on multiple cross-referenced signals. A score of 60+ triggers a HIGH risk classification.

Billing Pattern

Spike or bust-out patterns in monthly spending

25pt

New Entity + High Billing

Registered after 2021 with above-average volume

25pt

OIG Exclusion Match

Provider or official on the LEIE exclusion list

30pt

Multi-NPI Official

Same authorized official across multiple NPIs

15pt

Spending Percentile

Billing above the 95th percentile for taxonomy/state

30pt