Data Investigation
The Trillion Dollar Network
A visual journey through $1.09 trillion in Medicaid spending. Seven years of claims data. 617,000 providers. Every dollar traced.
Total Spending
Providers
Records
Top 1% of providers account for 80% of all spending
Chapter 1
Every Dollar Tells a Story
Before we can follow the money, we need to grasp the sheer magnitude of what we are looking at. These are not abstractions - they are the vital signs of America's safety net.
Scale
= $4,400 per American
Total Medicaid provider payments across 7 years of claims data. Enough to buy every NFL team five times over.
Reach
unique providers
From solo practitioners to billion-dollar hospital systems. Each one touches lives - and collects taxpayer dollars.
Depth
procedure codes
Every office visit, emergency response, therapy session, and drug injection - cataloged and priced.
Where does the money go?
Chapter 2
The Rising Tide
Monthly Medicaid spending from January 2018 to December 2024. Watch a pandemic reshape spending patterns, followed by an unprecedented surge - and then a sudden cliff.
Chapter 3
The Power Law
Medicaid spending follows a brutal concentration curve. A tiny fraction of providers collect the vast majority of payments. This is not a bell curve - it's a power law.
Top 1% of providers
~50% of spending
Top 10%
~27% of spending
Bottom 80%
<7% of spending
Gini Coefficient
~0.84 (extreme)
Chapter 4
The Connectors
Behind the numbers lies a network. Providers refer patients to each other, creating invisible corridors through which billions flow. Some nodes sit at critical junctions - the connectors who move the most money.
91
Provider Nodes
13
Referral Edges
$476.3M
Top Link Value
Chapter 5
Where the Money Goes
The top 20 procedure codes by total spending. Personal care services dwarf everything else - a sign of the long-term care system that Medicaid has become.
Chapter 6
The Few Who Move Billions
Meet the top 25 Medicaid providers by total spending. Each NPI represents an entity - a hospital system, a pharmacy benefit manager, a home care agency - that commands billions in public funds.
| Rank | NPI | Total Spending | Claims | Avg Cost/Claim |
|---|---|---|---|---|
| 1 | 1417262056 | $7.2B | 90M | $80 |
| 2 | 1699703827 | $6.8B | 31M | $220 |
| 3 | 1376609297 | $5.6B | 64M | $88 |
| 4 | 1699725143 | $3.1B | 108M | $29 |
| 5 | 1922467554 | $3.0B | 22M | $138 |
| 6 | 1710176151 | $2.7B | 36M | $75 |
| 7 | 1629436241 | $2.6B | 16M | $159 |
| 8 | 1982757688 | $2.3B | 2M | $1K |
| 9 | 1538649983 | $2.1B | 22M | $95 |
| 10 | 1528263910 | $1.7B | 5M | $371 |
| 11 | 1962650622 | $1.7B | 11M | $150 |
| 12 | 1720151046 | $1.5B | 8M | $186 |
| 13 | 1356709976 | $1.5B | 5M | $275 |
| 14 | 1396051694 | $1.4B | 9M | $154 |
| 15 | 1538144910 | $1.4B | 104M | $14 |
| 16 | 1447261540 | $1.4B | 9M | $161 |
| 17 | 1750504064 | $1.3B | 2M | $812 |
| 18 | 1417099789 | $1.3B | 6M | $217 |
| 19 | 1073055208 | $1.3B | 11M | $122 |
| 20 | 1376554592 | $1.2B | 2M | $769 |
| 21 | 1518096411 | $1.1B | 2M | $734 |
| 22 | 1700090834 | $1.1B | 15M | $75 |
| 23 | 1780816991 | $1.1B | 7M | $160 |
| 24 | 1275657553 | $1.1B | 8M | $145 |
| 25 | 1134250475 | $1.1B | 1M | $766 |
Click column headers to sort. NPI = National Provider Identifier.
Chapter 7
The Ecosystem
You have seen the numbers, the curves, and the connections. Now explore the full network yourself - an immersive canvas where every node is a provider, every edge a referral, and every dollar is traced.
Ready to explore the full network?
Interactive canvas with force-directed layout, zoom, search, and real-time filtering. See every connection in the $1.09 trillion ecosystem.
Explore the Full Network“The system isn't broken. It's working exactly as designed. The question is: designed for whom?”
Data source: HHS T-MSIS · 2018–2024