By AnneMarie Schieber, Heartland Institute
Government watchdog spending groups have a new opportunity to investigate Medicaid waste, fraud, and abuse – an “unprecedented” data drop by the U.S government.
The Department of Health and Human Services (HHS) released its “open data platform” on February 14, 2026.
Noting the “unprecedented” data release, Open the Books, a project of the non-profit organization American Transparency, discovered Medicaid paid over 270 million claims between 2018 and 2025, amounting to over $1 trillion, with little to no correlation between a state’s population and the amount it collected in Medicaid payments.
The organization looked at the ten states with the highest amounts of spending. New York topped the list with $142,242,871,454 in Medicaid payments received between 2018 and 2024. Yet, New York ranked fourth in 2024 population at 20,001,419.
Massachusetts came in fourth for Medicaid payments, at $55,367.680.853, despite it being at the bottom of the list for population at 7,138,560. New Jersey was close behind, ranking ninth in size of population, but bringing in the fifth highest amount in Medicaid payments at $46.451,305,414.
Comparatively, Florida ranked third in size of population but was ninth in Medicaid payments at $31,013,365,363.
The group also noted an explosion of spending for personal care services. “Billing under T1019 exploded from 2018 to 2024, going from $9.6 billion in 2018 to almost $23.5 billion in 2024,” Open the Books stated in a news release. “That’s an increase of about 144%.”
That is not surprising, says Merrill Mathews, a health care policy analyst and columnist for The Hill. “Much of the problem in both Medicaid and Medicare is the payment for home care and personal services,” said Matthews. “Programs that pay for care outside of the confines of a hospital or physician’s office are very susceptible to fraud. If groups are looking for fraud, home-care services that include paying relatives who provide care are a good place to start.”
The ‘Open-Source’ Approach
By taking an ‘open-source’ approach to huge troves of data, the Trump administration is hoping to improve the function of the federal government. The effort began immediately after President Donald Trump took office with the creation of the Department of Government Efficiency (DOGE).
Health care comprises 27 percent of all federal outlays, according to a KFFanalysis.
The goal of so-called data dumps is to improve transparency, innovation, and decision-making. On July 30, 2025, the Department of Health and Human Services (HHS) said it was making progress.
“Since the Trump Administration began, HHS has more than tripled the number of datasets on HealthData.gov—from approximately 3,000 in January 2025 to over 10,000 today,” said HHS Deputy Secretary Jim O’Neill, in a news release.
The project is a great idea, says Devon Herrick, a health care economist who worked in hospital accounting. “Private insurance companies tend to do this automatically with software,” Herrick told the Heartland Daily Podcast on February 27, 2026. “CMS does not really do it, or if they do, maybe a tiny bit.”
Herrick said years ago, the Wall Street Journal succeeded in getting Medicare claims data. “The doctors fought it tooth and nail, but it should be public data.”
Pushback
Some Medicaid providers have criticized the data release for “integrity concerns.”
“Any claims of fraud stemming solely from analysis of this data without significant context and background on aligned data sets should be met with skepticism,” stated LeadingAge, a provider serving seniors, in a February 25, 2026, news release.
By February 27, 2026, HHS had taken down the Medicaid spending data set. “This dataset is temporarily unavailable while we make improvements,” the site announced. “Check back soon.”
The data from big drops can be difficult to compare, says Matthews.
“The benefit, I believe, is that they could raise a red flag if numbers seem to be outliers, encouraging investigators to look more closely,” said Matthews. “For example, several years ago, Texas had a huge Medicaid fraud problem with pediatric orthodontic care. Texas was spending more Medicaid money on braces for low-income kids than all other states combined. Yet it was a local ABC news affiliate, not state or federal officials, who noticed the problem and exposed it. Access to data sets might have gotten more attention earlier.”
Matthews says the Vaccine Adverse Event Reporting System provides a good example.
“Anyone can report an adverse vaccine event, so it isn’t reliable,” said Matthews. “But if officials see a disproportionate number of, say, myocarditis cases being reported (as occurred with some Covid vaccines), that may be a clue to look closer at a specific vaccine.”
Crackdown on States
The database interruption has not stopped the Trump administration from cracking down on suspected Medicaid fraud. On February 25, 2026, Vice President J.D. Vance and Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz, M.D., announced a freeze of $259.5 million in Medicaid funding to Minnesota, citing unsupported or potentially fraudulent claims.
“For decades, Medicare fraud has drained billions from American taxpayers—that ends now,” said Health and Human Services Secretary Robert F. Kennedy. “We are replacing the old ‘pay and chase’ model with a real-time ‘detect and deploy’ strategy, using advanced AI tools to identify fraud instantly and stop improper payments before they go out the door.”
Gov. Tim Walz called it a “campaign of retribution.” MN Attorney General Keith Ellison introduced legislation to improve enforcement against Medicaid fraud, including increased criminal penalties and expanding the state’s Medicaid fraud unit.
Federal prosecutors estimate fraud losses in Minnesota could exceed $9 billion.
Texas is beefing up its investigations into Medicaid Fraud, while an audit revealed Maine made at least $45.6 million in improper Medicaid services for Autism. A 2021 audit found nearly all Medicaid agencies paid $289 million on behalf of deceased enrollees.
Public Sleuths
Meanwhile, Treasury Secretary Scott Bessent announced on February 13 that his department would provide financial rewards for whistleblower tips. The rewards could be substantial.
“The availability of significant monetary awards for exposing fraud could be a game changer if done correctly,” said Matthews. “But as we have seen in the Minnesota welfare fraud case, bureaucratic, political, and beneficiary resistance to whistleblowers can be daunting. Plus, if the rewards are significant, you could see lots of people claiming to have identified fraud when there was none, or at least not that would convince a jury.
AnneMarie Schieber is a research fellow at The Heartland Institute and managing editor of Health Care News.
