Medicaid Data Dump: Billing Codes Explode Up to 10,000%, LA Mental Health Dept. Highest Biller in the Nation

Last week, the Department of Health and Human Services dropped an unprecedented amount of new data to improve public transparency and reduce fraud: over 270 million payments made by Medicaid from 2018-2024. They amount to over a trillion dollars worth of taxpayer funds.

Open the Books broke down the data.

Payment amounts generally increased over time, with a notable bump starting in 2020 in response to COVID-related spending and increased enrollment due to economic hardship caused by government-imposed economic shutdowns.

Monthly Medicaid spending 2018-2024 as reported in HHS Open Data.

The states with the highest amounts of spending include New York, California, and Texas. But spending does not always correlate with population. Massachusetts and New Jersey, with 7 million and 9.5 million people respectively, have higher spending than more populous states like Florida and Pennsylvania. These top ten states represent $605 billion in spending, or over half of all spending during the time period covered.

Top ten states for Medicaid spending, including estimated population in 2024 from census.gov.

All spending has an corresponding billing code, which indicates what service is being billed for. Twenty-five billing codes represent half of all claims ($505 billion).

Top 25 billing codes by amount spent from 2018-2024. Billing code service descriptions taken directly from CMS.gov or AAPC.com [Link to Data]:

A huge proportion of spending is under code T1019, which covers personal care services. This billing code is for home and community-based care services as an alternative to residential nursing homes. Elderly or disabled people can stay in their homes and in some states hire friends and relatives to care for them using taxpayer dollars. The scheme is especially popular in New York State, which has seen $72.7 billion in such spending from 2018-2024. That’s the most of any state, and accounts for roughly half of all New York Medicaid spending.

Billing under T1019 exploded from 2018 to 2024, going from $9.6 billion in 2018 to almost $23.5 billion in 2024. That’s an increase of about 144%.

Spending under billing code T1019 from 2018 to 2024. [Link to data here].

Within that timeframe, eleven organizations were paid out over $1 billion under T1019. Nine of them are headquartered New York. The other two are located in Massachusetts.

Organizations receiving over $1 billion in T1019 funds from 2018 to 2024 [Link to data here]:

Across all billing codes, 46 entities have received over $1 billion in Medicaid spending and 16 received over $2 billion.

Organizations receiving over $2 billion in Medicaid spending across billing codes, 2018-2024 [Link to data]:

More Billing Codes See Skyrocketing Billing

T1019 is not the only billing code with explosive growth from 2018 to 2024, although it is the code with the highest amount paid out in that time. Twenty-two other codes saw anywhere from 200% to over 10,000% increases. Eight codes had over 500% more payments.

Billing codes with an over 500% increase in payments from 2018-2024 [Link to data here]:

The item with the highest increase, W1793, encompasses Pennsylvania’s Personal Assistance Service. This code is like the T1019 billing code but only for Pennsylvania. Payments soared from $5.6 million to $583 million in that time, largely beginning in 2021. That’s an increase of 10,283%.

Increase in W1793 spending, 2018-2024 [Link to data here].

Similarly, spending under G9005 for “coordinated care” dramatically increased almost 3,500% due to an overall increase in home-based care nationwide. The G9005 billing code covers case management and coordination between multiple healthcare providers for a given patient. Spending went from $9.9 million in 2018 to $351 million in 2024, with the biggest increase occurring in 2019 to over $120 million.

Increase in G9005 spending, 2018-2024 [Link to data here].

Centers for Medicare & Medicaid Services: The Bureaucrats Behind the Numbers

The Centers for Medicare & Medicaid Services are a division of Health and Human Services charged with administering Medicare & Medicaid spending and programs for around 100 million program participants.

Staff and salary data for the agency is not yet available for 2025, but Open the Books has the most recently available data, for 2024.

Access the Open the Books sets of CMS Staff and Salary Data here.

In 2024, 6,535 CMS staffers drew a paycheck, with total salaries worth about $918 million. This doesn’t include other benefits like healthcare and retirement funds, which add another estimated 30% to each salary.

Most employees, 4,304, are based in either D.C. or Maryland, where they enjoy location-based bonus adjustments to their salaries for living in a high-cost area.

A little less than half of employees, or 2,845, have the title “Health Insurance Administration” and have a combined income of $405 million. The next most frequent titles are “Information Technology Management” (754 staffers, $112 million in salaries), and “Management and Program Analysis” (565 staffers, $71 million in salaries).

Some other notable titles include “Social Science” (259 staffers, $51 million in salaries), “General Arts and Information” (63 staffers, $9 million in salaries), and “Public Affairs” (27 staffers, $4 million in salaries).

Across the agency, salaries average over $140,000. Eighty-three staffers had an over $200,000 salary, and 5,785 made between $100,000 and $199,999.

Biden-era CMS Administrator Chiquita Brooks-LaSure, according to a press release, “charged CMS to advance health equity across the CMS programs,” and had a salary of $168,400.

Brooks-LaSure’s pay was still quite a bit lower than long-term bureaucrats like Chief Medical Officer Dr. Shari Ling, who directs the Center for Clinical Standards and Quality (CCSQ). Ling took home a $252,900 salary in 2024.

According to the CMS website, CCSQ is responsible for “executing all national clinical, quality, and safety standards for healthcare facilities and providers, as well as establishing coverage determinations for items and services that improve health outcomes for Medicare beneficiaries.”

The next highest paid CMS professional, Dr. Michelle Schreiber, had a similar $250,950 salary in 2024. She is currently the Deputy Director of the Center for CCSQ and the Director of the Quality Measurement and Value-Based Incentives Group. These positions attempt to measure and improve healthcare quality. According to a press release, she also led the group’s work on “health equity.”

Under Trump, CMS is led by Dr. Mehmet Oz. According to news articles, the agency planned on cutting 300 roles as part of a “reductions in force” measure undertaken across federal agencies in 2024. The administration has not yet released its full 2025 staff and salary numbers, however, so it is unclear which and how many staffers were let go or replaced.

Open the Books commends the release of the Medicaid dataset, which provides crucial information on some of our biggest public expenditures. Taxpayers can understand, with real dollar figures, how policies have increased the cost of the Medicaid program and which businesses are benefiting the most, perhaps even through fraud.

Spending transparency is a key tenet of a functional democracy, and we hope the Trump administration continues releasing data for more years and more programs.

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