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.
Episodes
Seasons
Records Analyzed
Total Spending
Your Hosts
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.
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
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.
The Billion Dollar Question
Medicaid spending exploded 82% in five years while beneficiary growth was only 52%. Twenty-five providers control 40% of all spending. We follow the money.
The Invisible Giant
NPI 1417262056 billed $7.18 billion over seven years — 90 million claims, 35,000 per day. But its identity is redacted. Who is the invisible giant?
The T1019 Economy
Personal care services code T1019 accounts for $122.7 billion — 11.2% of all Medicaid. It grew over 100% while the system grew 52%. One procedure code tells the whole story.
Three Degrees of Separation
155 top providers. 2,740 connections. 9 communities. The Medicaid system is not random chaos — it has hidden structure. And a few providers hold it all together.
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.
The 2024 Cliff
Spending dropped 76% in 2024. Ten million people disenrolled. Is it a collapse or a reset? Understanding who got left behind tells us everything.
Who Owns Medicaid?
Private equity is buying up Medicaid providers. Solo practices become aggregators become financial platforms. The system is consolidating — and nobody tracks who owns what.
The Price Is Wrong
The same procedure billed at 5x to 10x different rates in the same state. In any normal market, this triggers antitrust investigations. In Medicaid, it is invisible.
The Reckoning
Season finale. We bring all threads together — growth, concentration, networks, ownership, pricing. Data does not lie. But silence does. And we have to break it.
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.
Total Records
Unique Providers
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