OpenMedicaid – Analyzes $1 trillion in Medicaid payments for fraud detection

Summary: OpenMedicaid analyzes 227 million rows of Medicaid spending data from 2018-2024, covering $1.09 trillion in payments. It uses two machine learning models and a risk watchlist to flag $229.6 billion in suspicious spending.

What it does

It applies ML fraud detection models to Medicaid provider data and offers detailed profiles, procedure pages, state breakdowns, and investigation articles, cross-referenced with the HHS OIG exclusion list.

Who it's for

Researchers, journalists, and analysts investigating Medicaid fraud and provider spending patterns.

Why it matters

It identifies and highlights potentially fraudulent Medicaid spending to support oversight and accountability.