Follow the money.
$1.09 trillion in
Medicaid spending.

We analyzed 227 million Medicaid billing records released by HHS, covering 617,503 providers (594,235 met minimum billing thresholds for ML scoring) and 10,881 procedure codes from 2018–2024. We combined 9 statistical risk tests — including 4 code-specific smart tests that compare each provider's cost per claim against the national median — with a random forest ML model (AUC: 0.77) trained on 514 OIG-excluded providers. These are unified into risk tiers (Critical, High, Elevated, ML Flag) for a single view of the most suspicious billing patterns.