About the Series

Follow the Billions is a data-driven investigative podcast that traces how $1.09 trillion in Medicaid spending flows through a system of 617,000 providers — and what the data reveals about concentration, pricing, and power.

8

Episodes

2

Seasons

227M

Records Analyzed

$1.09T

Total Spending

Your Hosts

MC

Marcus Cole

Data & Analysis

Former HHS data analyst turned independent researcher. Marcus spent eight years inside the federal healthcare data infrastructure, working directly with T-MSIS claims data and provider enrollment systems.

He reads Medicaid data the way most people read spreadsheets — spotting patterns in billing volumes, identifying anomalous provider behavior, and building network models that reveal the hidden structure of the system. For Follow the Billions, Marcus processed 227 million records spanning 2018 to 2024, building the analytical foundation for every episode.

His specialties include claims analysis, provider network modeling, and spending concentration metrics. He believes that public data should tell public stories.

SC

Sarah Chen

Policy & Investigation

Healthcare policy reporter with over a decade covering Medicaid, Medicare, and the intersection of public health and private profit. Sarah has reported from state capitols, congressional hearings, and community health centers across the country.

She asks the questions that make bureaucrats uncomfortable and turns data into stories people understand. For Follow the Billions, Sarah translates Marcus's quantitative findings into narrative journalism — connecting spending patterns to real policy decisions and real human consequences.

Her reporting has focused on provider consolidation, Medicaid managed care, the growing role of private equity in healthcare, and the impact of the Public Health Emergency unwinding on vulnerable populations.

Season Overview

Season 1

The Machinery

Season 1 maps the Medicaid system from the top down. We start with the headline number — $1.09 trillion — and progressively zoom in: from aggregate spending trends, to individual providers controlling billions, to the single procedure code that dominates the system, to the hidden network structure connecting it all. By the end, you understand not just how much money flows through Medicaid, but how it flows, and who controls the channels.

Season 2

The Reckoning

Season 2 follows the consequences. The 2024 enrollment cliff sends shockwaves through the system. Private equity reshapes provider ownership. Pricing dysfunction becomes impossible to ignore. And in the finale, we bring every thread together into a single, unavoidable conclusion: the system needs fundamental transparency reform.

Production

DataPulse Media

Follow the Billions is produced by DataPulse Media, a production studio dedicated to data-driven investigative journalism. We believe public data should tell public stories, and that complex systems become understandable when you follow the money.

thedayda181

Created and developed by thedayda181. From data pipeline to podcast production to interactive visualization, this project is an end-to-end demonstration of what happens when you combine public data access with curiosity and persistence.

Data Source

HHS T-MSIS Analytic Files

All analysis in Follow the Billions is based on the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files, accessed through the CMS Integrated Data Repository (IDR). The dataset spans January 2018 through December 2024 and contains approximately 227 million aggregated records covering claims, providers, beneficiaries, and procedure codes.

227M

Total Records

617K

Unique Providers

2018-2024

Date Range

Limitations

  • 2024 data is preliminary and subject to revision by CMS
  • Some provider NPIs are redacted in the public-use files, limiting identification
  • No clinical outcome data is included — spending does not equal care quality
  • State-level variation in reporting standards may affect cross-state comparisons
  • Aggregated records do not include individual beneficiary-level detail