In February 2025, the Department of Health and Human Services released an unprecedented dataset covering over 270 million Medicaid payments totaling more than a trillion dollars from 2018 to 2024. The watchdog organization OpenTheBooks analyzed this massive data dump, revealing startling patterns in billing code usage and spending increases that raise serious questions about program growth and potential fraud.
The analysis uncovered dramatic spending surges across multiple billing codes. Twenty-two codes saw increases ranging from 200% to over 10,000%, with eight codes experiencing growth exceeding 500%. The most alarming example involves Pennsylvania's Personal Assistance Service (billing code W1793), which skyrocketed from $5.6 million in 2018 to $583 million in 2024—a staggering 10,283% increase.
California's Los Angeles County Department of Mental Health emerged as the single highest-billing entity in the entire nation, drawing scrutiny over whether this reflects genuine need or systemic inefficiency.
Billing code T1019, which covers personal care services for home and community-based care, dominated the landscape. This program allows elderly and disabled individuals to hire friends and relatives as caregivers using taxpayer funds—a structure particularly popular in New York State.
New York spent $72.7 billion on T1019 services from 2018 to 2024, representing approximately half of all state Medicaid spending. Nationally, T1019 spending exploded from $9.6 billion in 2018 to nearly $23.5 billion in 2024—a 144% increase. Nine of the eleven organizations receiving over $1 billion under this code are headquartered in New York.
The coordinated care billing code G9005 saw spending jump from $9.9 million in 2018 to $351 million in 2024—a 3,500% increase. This code covers case management services between multiple healthcare providers.
State spending patterns reveal significant disparities. While population-heavy states like New York, California, and Texas led in absolute spending, smaller states like Massachusetts and New Jersey outspent more populous states like Florida and Pennsylvania, suggesting policy-driven rather than demand-driven spending variations.
The Centers for Medicare & Medicaid Services (CMS), the agency administering these programs, employed 6,535 staffers in 2024 with combined salaries of approximately $918 million. The average CMS salary exceeded $140,000, with 83 employees earning over $200,000. Under the Biden administration, CMS Administrator Chiquita Brooks-LaSure emphasized advancing "health equity," while top medical officers like Dr. Shari Ling earned $252,900.
The Trump administration, now led by Dr. Mehmet Oz at CMS, has announced plans to cut approximately 300 positions as part of broader workforce reductions across federal agencies.
OpenTheBooks commended the HHS data release as a crucial step toward government accountability. The organization argues that such transparency enables taxpayers to understand how policy decisions translate into real-dollar expenditures and helps identify potential waste, fraud, and abuse.
With 46 entities receiving over $1 billion each in Medicaid funds during the six-year period, and 16 organizations collecting over $2 billion, the data provides a roadmap for investigators seeking to ensure taxpayer dollars serve intended beneficiaries rather than enriching well-connected healthcare providers.
