Insights

Research notes on Medicaid payment integrity.

Analysis of public federal data on where Medicaid dollars concentrate, what exclusion screening can and cannot see, and what the Department of Justice now asks of analysis offered as evidence. Each figure cites its source. Notes report population-level aggregates of public data, name no provider and make no allegation about any provider.

The same year, counted two ways

Medicaid billing NPIs, service year 2023, ranked from the smallest billers on the left to the largest on the right. Dollars are claim payments attributed to a billing NPI in the HHS provider-spending file.

Billing NPIsBottom 50%: 50% of billing NPIs50th to 90th percentile: 40% of billing NPIs90th to 99th: 9% of billing NPIs99th to 99.9th: 0.9% of billing NPIsTop 0.1%: 0.1% of billing NPIsTop 1%: 3,596 NPIsPaid dollarsBottom 50%: 0.77% of paid dollars50th to 90th percentile: 14.59% of paid dollars90th to 99th: 38.53% of paid dollars99th to 99.9th: 26.86% of paid dollarsTop 0.1%: 19.25% of paid dollarsTop 1%: 46.1% Billing NPIsBottom 50%: 50% of billing NPIs50th to 90th percentile: 40% of billing NPIs90th to 99th: 9% of billing NPIs99th to 99.9th: 0.9% of billing NPIsTop 0.1%: 0.1% of billing NPIsTop 1%: 3,596 NPIsPaid dollarsBottom 50%: 0.77% of paid dollars50th to 90th percentile: 14.59% of paid dollars90th to 99th: 38.53% of paid dollars99th to 99.9th: 26.86% of paid dollarsTop 0.1%: 19.25% of paid dollarsTop 1%: 46.1%
Fig. 1Data. Shares of billing NPIs and of $200.9 billion in claim payments with a billing NPI, by rank group, service year 2023. Bands from left: bottom 50%, 50th to 90th percentile, 90th to 99th, 99th to 99.9th, top 0.1%. Figures may not sum due to rounding. Source: HHS, Medicaid Provider Spending by HCPCS, version 2026-02-09; file dated April 6, 2026; rows with a billing provider NPI. T-MSIS fee-for-service, managed care and CHIP claim lines. 2024 is preliminary.
Top 1% of billing NPIs
3,596 NPIsreceived 46.1% of those dollars in 2023.
Top 0.1%
360 NPIsreceived 19.3%.
Bottom half
About 179,800 NPIsreceived less than 0.8%.

Research notes

Published by Marque Analytics. Each note states the date of its data and lists its sources. Notes are added as analysis completes.

Medicaid spendingResearch noteData: file dated Apr 6, 20269 min

Where Medicaid money concentrates

In the HHS provider-spending file, the top 1% of billing NPIs received 45.6% to 47.7% of the paid dollars attributed to a billing NPI in every year from 2018 to 2024 (2024 is preliminary). NPIs paid $100 million or more in a year rose from 31 in 2018 to 104 in 2023. Those are nominal dollars: total paid rose 83% over the same years, and state managed-care reporting improved. With three charts, the method and the caveats.

46.1%

of 2023 paid dollars attributed to a billing NPI went to the top 1% of billing NPIs.Source: HHS provider-spending file, version 2026-02-09, file dated April 6, 2026

Exclusion screeningResearch noteData as of Mar 14, 20267 min

The NPI gap in exclusion screening

Only 8,482 of 82,749 records on the OIG exclusion list, as downloaded March 14, 2026, carry an NPI. What Medicaid payment data show for the ones that do, and what name and entity resolution adds for the rest.

10.25%

of OIG exclusion records carry an NPI, as of March 14, 2026.Source: HHS OIG, List of Excluded Individuals/Entities

False Claims ActExplainerSources current through Oct 7, 202610 min

What DOJ’s FOCUS initiative means for statistical evidence in False Claims Act matters

The April 30, 2026 announcement, the July 17 white paper questionnaire, the pleading lessons of the Fifth and Ninth Circuit Integra decisions, and questions counsel can ask of data-driven allegations. General information, not legal advice.

22%

Approximate share of qui tams the government pursued, per DOJ.Source: DOJ Civil Division, FOCUS initiative, April 30, 2026

The research informs two practices: payment integrity for health plans and state program integrity units, and litigation support for counsel.

Standards

How these notes are written.

The same rules apply to every note.

Editorial standards Research notes

i. Public sources, cited
Every figure links to the dataset or document it comes from, with the version and date.
ii. No provider named
Small groups are reported only as totals and are not broken down further.
iii. Conservative figure first
Where a stricter count exists, it leads. The broader count follows with its caveat.
iv. Method on the page
Definitions, checks and limits are stated in each note.
v. Patterns are not findings
Concentration, growth and matches between public files describe where to look. They are not conclusions about anyone.
vi. Not legal advice
Notes on enforcement summarize public documents. Marque is not a law firm. On legal matters, it works at the direction of counsel.
vii. Public files only
Notes use only public national files. They are never drawn from, or narrowed toward, work prepared for a client or for counsel.
viii. Aggregates only
Notes report population-level totals across the national file. No group small enough to be tied to a provider or a matter is counted or broken down, and analysis prepared for a matter is never published.

Request an introduction.

Questions about this research, or about your own network. A senior member of the firm replies within one business day, and we sign a mutual NDA before discussing specifics.

Reply
Within one business day, from a senior member of the firm
Confidentiality
Mutual NDA before any data or specifics change hands
Conflicts
Every mandate is checked for conflicts before an NDA is signed.

Request for introduction

General terms only