TRILLION-DOLLAR DRAIN:

 

INVESTIGATIVE REPORT

How Fraud, Waste, and Abuse Are Hollowing Out America's Medicaid and Medicare Programs

February 21, 2026  |  Special Investigative Report

BLUF (Bottom Line Up Front):

Federal health entitlement programs — Medicaid and Medicare — disbursed over $1 trillion in Medicaid payments alone from 2018 to 2024, with the Department of Health and Human Services (HHS) estimating that between $60 billion and $100 billion is lost annually to fraud, waste, and abuse across both programs. New transparency data released by HHS in February 2026 exposes explosive billing-code growth of up to 10,283%, a concentration of payouts among a handful of organizations, and systemic vulnerabilities that have persisted across multiple administrations. Aggressive enforcement, real-time data monitoring, and congressional oversight are urgently needed to protect American taxpayers and the program's most vulnerable beneficiaries.

BACKGROUND: THE SCOPE OF FEDERAL HEALTH SPENDING

The United States federal government operates two massive health entitlement programs: Medicare, which serves approximately 67 million elderly and disabled Americans, and Medicaid, a joint federal-state program covering roughly 90 million low-income individuals. Together, these programs represent the single largest category of domestic discretionary and mandatory federal spending.


In fiscal year 2024 alone, combined federal expenditures on Medicare and Medicaid exceeded $1.6 trillion, according to the Congressional Budget Office (CBO). Medicare outlays topped $1.05 trillion, while the federal share of Medicaid approached $600 billion — figures that have grown dramatically over the past decade as enrollment expanded, COVID-19 relief packages inflated costs, and post-pandemic "unwinding" exposed enrollment irregularities.


The Centers for Medicare & Medicaid Services (CMS), a division of HHS, administers both programs with a workforce of approximately 6,500 employees drawing combined salaries of $918 million per year. That bureaucracy, according to fiscal watchdog group OpenTheBooks, has been largely unable to prevent the systematic exploitation of billing loopholes that has allowed fraud to flourish at scale.

NEW DATA: HHS DROPS UNPRECEDENTED TRANSPARENCY TROVE

In a significant move toward public accountability, HHS released in February 2026 a dataset encompassing over 270 million Medicaid payments totaling more than $1 trillion, covering the period 2018 through 2024. The release, coordinated with CMS's open data initiative, was quickly analyzed by OpenTheBooks, the nonpartisan government transparency nonprofit founded by Adam Andrzejewski.


The data reveals several alarming patterns. Twenty-five billing codes alone account for fully half — $505 billion — of all Medicaid claims over the six-year period. The single largest category, billing code T1019, covering Personal Care Services allowing homebound elderly and disabled patients to hire friends and relatives as caregivers, totaled disbursements that grew 144% from $9.6 billion in 2018 to $23.5 billion in 2024. New York State was the dominant actor, receiving $72.7 billion under T1019 — approximately half of all New York Medicaid spending — a figure that watchdogs and state auditors have scrutinized for years amid persistent fraud allegations.


Even more striking is the trajectory of several billing codes that saw three- to four-digit percentage increases over the same six-year window. The most extreme case, billing code W1793 covering Pennsylvania's Personal Assistance Service, saw payments explode from $5.6 million in 2018 to $583 million in 2024 — a 10,283% increase. Billing code G9005, covering coordinated care case management, surged nearly 3,500%, from $9.9 million to $351 million.


In total, 22 billing codes experienced increases of 200% or more, and eight codes saw increases exceeding 500%. While some of this growth reflects legitimate expansion of home- and community-based services as a cost-effective alternative to institutional care, investigators and auditors say the scale and speed of growth are consistent with systemic exploitation.

FRAUD LANDSCAPE: WHAT THE NUMBERS CONCEAL

According to the most recent data from the HHS Office of Inspector General (OIG), improper payments in Medicaid totaled an estimated $50.3 billion in FY 2023 — representing an improper payment rate of approximately 5.1% of total Medicaid outlays. Medicare improper payments were separately estimated at $31.3 billion for the same fiscal year, according to the Medicare Fee-for-Service (FFS) program's Comprehensive Error Rate Testing (CERT) data.


The Department of Justice (DOJ) Health Care Fraud Unit, working through the Medicare Fraud Strike Force, charged 193 defendants in FY 2023 with fraudulently billing Medicare and Medicaid for approximately $2.75 billion in false claims — the largest annual enforcement action in the program's history. Charges spanned schemes including:


Billing for services never rendered, including home health visits, physical therapy, and durable medical equipment.


Unnecessary prescriptions for opioids and controlled substances billed to Medicare Part D.


Personal care attendant fraud, including the enrollment of fictitious caregivers or the billing of hours while recipients were hospitalized, incarcerated, or deceased.


Telehealth fraud — particularly post-COVID, when relaxed oversight rules enabled fraudsters to bill for fictitious remote consultations at massive scale.


Substance abuse treatment billing fraud through so-called "patient brokering" networks, concentrated in Florida, California, and Texas.

PERSONAL CARE FRAUD: A SYSTEMIC VULNERABILITY

The personal care services billing category — encompassing T1019 and analogous state-specific codes — has long been identified by OIG, GAO, and state Medicaid fraud control units (MFCUs) as uniquely susceptible to exploitation. Unlike acute medical services, personal care is often provided in private homes without direct supervision, making verification difficult.


A 2022 OIG report on Medicaid personal care services found that CMS and states lacked adequate safeguards to prevent improper payments, noting that states could not verify that services were actually delivered in a significant percentage of sampled claims. In New York, the state comptroller's office has repeatedly flagged the Consumer Directed Personal Assistance Program (CDPAP) — the program that drives much of the T1019 billing — for fraud vulnerabilities, issuing audit findings in 2019, 2021, and 2023 that identified tens of millions in unsupported claims.


The February 2026 OpenTheBooks analysis found that eleven organizations each received over $1 billion under T1019 billing from 2018 to 2024. Nine of the eleven are headquartered in New York; the remaining two are in Massachusetts. The concentration of such enormous sums among a small number of entities raises questions about oversight and potential collusion that federal and state investigators have been slow to address.


In a high-profile case emblematic of the problem, federal prosecutors in the Southern District of New York indicted in 2024 the operators of several home health agencies on charges of defrauding Medicaid of more than $88 million through fictitious personal care billing. The agencies had enrolled thousands of "caregivers" who performed little or no actual work, with payments flowing to a network of related entities through management fees and lease arrangements.

LOS ANGELES MENTAL HEALTH: NATION'S HIGHEST MEDICAID BILLER

Among revelations flagged in the OpenTheBooks analysis is that the Los Angeles County Department of Mental Health is the highest Medicaid-billing local government mental health entity in the nation. While some proportion of this billing reflects legitimate services in one of the nation's largest and most stressed public mental health systems, the finding has drawn renewed scrutiny from California state legislators and federal oversight officials.


The California State Auditor's office issued a report in 2023 criticizing the Los Angeles Department of Mental Health for inadequate documentation of Medicaid-billable services, finding that the department could not fully substantiate claims worth tens of millions of dollars. The auditor recommended enhanced supervisory review and electronic documentation systems — reforms that, as of early 2026, have been only partially implemented.

TELEHEALTH: COVID'S FRAUD LEGACY

The COVID-19 pandemic's legacy of relaxed telehealth oversight has proven a fertile ground for fraudsters. Congress and CMS temporarily waived numerous in-person requirements to expand access to care — a policy decision with legitimate clinical rationale — but the loosened standards created opportunities for fraud that investigators are still working to unwind.


The DOJ has brought dozens of telehealth fraud cases since 2021. In 2023 alone, DOJ charged defendants in a nationwide telehealth scheme that allegedly submitted over $1.5 billion in false Medicare claims for medically unnecessary durable medical equipment and prescription drugs. Telemedicine companies served as fronts, signing off on thousands of prescriptions after superficial or nonexistent patient consultations, with physicians paid kickbacks for their signatures.


The Senate Finance Committee, in a bipartisan investigation released in late 2024, found that CMS had inadequate systems to detect and prevent telehealth billing anomalies in real time, and that post-payment reviews consistently recovered only a small fraction of estimated fraudulent payments. The committee recommended expanding the use of artificial intelligence and predictive analytics tools — capabilities that GAO has also advocated in multiple prior reports.

STRUCTURAL VULNERABILITIES: PAY AND CHASE FAILURE

A recurring theme in oversight literature is that CMS's dominant fraud control model — known colloquially as "pay and chase" — allows fraudulent claims to be paid before investigation and attempts recovery after the fact. Recovery rates are poor: OIG data suggests that for every dollar of identified improper payments, the government recovers less than 20 cents on average.


The GAO has designated Medicare and Medicaid as "high-risk" programs continuously since 1990 — a designation that remains in effect more than three decades later. GAO's February 2025 update to the High-Risk List cited continued deficiencies in CMS's program integrity efforts, inadequate oversight of managed care organizations (MCOs) — which now deliver the majority of Medicaid services — and slow adoption of data analytics as persistent vulnerabilities.


CMS processes nearly four billion Medicare and Medicaid claims annually. The sheer volume, combined with a complex and fragmented system of state-administered Medicaid programs operating under varied waiver authorities, makes comprehensive real-time oversight extraordinarily difficult. GAO has found that CMS oversight of managed care — into which over 70% of Medicaid enrollees have been shifted — is significantly weaker than oversight of fee-for-service billing, creating a substantial blind spot.

THE TRUMP ADMINISTRATION: REFORM OR DISRUPTION?

Under the second Trump administration, CMS is now led by Dr. Mehmet Oz, whose appointment drew both attention and skepticism from health policy experts. The administration has announced plans to reduce the CMS workforce by approximately 300 positions as part of a broader federal workforce reduction initiative, though detailed lists of eliminated roles have not been publicly released.


Supporters of the workforce reduction argue that a leaner agency could redirect resources toward fraud prevention technology rather than administrative overhead. Critics, including former CMS officials interviewed by multiple outlets, warn that reducing program integrity staff — particularly those conducting audits and investigations — could worsen fraud loss rates in the near term. OIG has historically estimated that every dollar invested in healthcare fraud enforcement returns between $3 and $7 in recovered funds.


The administration has also signaled interest in expanding state flexibility through Medicaid waivers, including potential work requirements for able-bodied adult enrollees — a policy previously attempted in several states but blocked by courts. Such structural changes could reduce enrollment and costs, but may also create transitional administrative burdens and coverage gaps affecting vulnerable populations.


The February 2026 HHS data release has been broadly welcomed across the political spectrum as a transparency improvement. OpenTheBooks founder Adam Andrzejewski stated that "taxpayers can now 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." Congressional oversight committees in both chambers have announced plans to hold hearings on the data's findings.

HIGH-RISK ORGANIZATIONS: CONCENTRATED PAYOUTS RAISE FLAGS

The OpenTheBooks analysis found that 46 entities received over $1 billion in cumulative Medicaid payments from 2018 to 2024, with 16 receiving over $2 billion. While many of these organizations are legitimate large-scale healthcare providers, the concentration of federal funding raises governance questions. Large managed care organizations, home health conglomerates, and Medicaid-focused behavioral health providers dominate the list.


OIG has in past years investigated several of the nation's largest Medicaid managed care organizations for alleged underpayments to providers, churning of high-cost enrollees, and overbilling of risk adjustment factors. In 2023, Centene Corporation, one of the largest Medicaid managed care operators in the nation, agreed to pay $165 million to resolve allegations that it overcharged state Medicaid programs for pharmacy benefit services — the largest such settlement in the program's history at that time.

CONGRESSIONAL AND STATE ACTIONS

Congress has taken several steps to address Medicaid and Medicare integrity in recent years, though critics argue legislative responses remain inadequate relative to the scale of losses:


The Consolidated Appropriations Act of 2023 extended enhanced federal medical assistance percentage (FMAP) funding while requiring states to complete Medicaid eligibility redeterminations after the COVID-era continuous enrollment pause — a process that identified millions of ineligible enrollees.


The Improving Seniors' Timely Access to Care Act of 2022 required CMS to modernize and streamline Medicare Advantage prior authorization processes, though implementation has been contentious.


The Senate Finance Committee's 2024 bipartisan report on telehealth fraud recommended CMS adopt an AI-driven pre-payment review system for high-risk billing categories — legislation to mandate this was introduced but not enacted as of publication.


At the state level, New York's 2025 Medicaid reform package included new oversight provisions for CDPAP, including electronic visit verification requirements for all home care hours. The reforms followed years of advocacy from the state comptroller and a series of high-profile federal prosecutions.

LOOKING AHEAD: WHAT REFORM REQUIRES

Healthcare fraud and program integrity experts, surveyed in the wake of the HHS data release, broadly agree on a set of structural reforms necessary to materially reduce waste, fraud, and abuse:


Pre-payment fraud screening: Transitioning from pay-and-chase to a pre-payment review model for high-risk billing categories, enabled by AI and machine-learning tools already piloted in limited form by CMS.


Electronic visit verification: Full national implementation of EVV for all home health and personal care services, as mandated by the 21st Century Cures Act, closing the verification gap that drives personal care fraud.


Managed care oversight: Expanding CMS authority to audit MCO subcontractors and requiring standardized encounter data that enables fraud detection equivalent to fee-for-service.


Provider enrollment reform: Tightening enrollment standards, expanding background check requirements, and implementing cross-program data matching to identify providers excluded from one program but active in others.


Transparency continuation: Sustaining and expanding the HHS open-data initiative to enable independent analysis by investigative journalists, academics, and watchdog organizations.


MEDICARE BENEFICIARY SELF-PROTECTION GUIDE
What Every Senior Needs to Know — and Do — to Guard Their Benefits







BOTTOM LINE: Medicare fraud is not an abstract government problem — it directly threatens your benefits, your credit, and your personal medical identity. Beneficiaries who actively monitor their accounts, guard their Medicare number, and promptly report suspicious charges are the single most effective line of defense. Most fraud victims had no idea it was happening until significant damage was done.



WHY THIS MATTERS DIRECTLY TO YOU


When fraudsters bill Medicare in your name — for services you never received, equipment you never ordered, or visits from providers you never saw — several serious consequences follow:


Your Medicare records become corrupted with false diagnoses, procedures, and prescriptions that future physicians may act on.


Your coverage limits for certain services (skilled nursing, home health, durable medical equipment) can be exhausted by fraudulent claims before you actually need them.


Your personal information — Medicare Beneficiary Identifier (MBI), Social Security Number, and health history — can be sold on the dark web and used in identity theft schemes well beyond Medicare.


Aggregate fraud raises program costs, accelerating political pressure to reduce benefits or increase premiums for all seniors.


The HHS Office of Inspector General estimates that tens of billions of dollars in fraudulent Medicare claims are filed every year, and that individual beneficiaries are the most under-utilized resource in detecting it early.


STEP 1: READ YOUR MEDICARE SUMMARY NOTICE (MSN) — EVERY TIME


CMS mails a Medicare Summary Notice (MSN) every three months listing all claims billed to Medicare in your name. Most beneficiaries file these without reading them. That is a critical mistake.


Review every line item. Verify that every provider, date, and service actually matches your memory of care received.


Check for providers you have never visited. A provider name you don't recognize billing for an office visit is a red flag.


Watch for duplicate charges — the same service billed twice in the same period.


Flag equipment you never received: power wheelchairs, back braces, diabetic supplies, and CPAP machines are among the most commonly billed fraudulent items.


Note charges for services on dates you were hospitalized, traveling, or otherwise unable to have received outpatient care.


If you are enrolled in Medicare Advantage (Part C), your plan will send an Explanation of Benefits (EOB) rather than an MSN. Read it with the same level of scrutiny.


STEP 2: USE MyMedicare.gov — DON'T WAIT FOR THE MAIL


Create a free account at MyMedicare.gov (medicare.gov/account/login) to access your claims in near real time — typically within 24 hours of processing — rather than waiting for the quarterly paper MSN.


Log in monthly and scan your claims history.


Use the "Blue Button" feature to download your complete claims history as a data file — useful for sharing with your personal physician or a trusted family member who helps manage your care.


Set up email or text alerts for new claims activity if your account options permit it.


STEP 3: GUARD YOUR MEDICARE BENEFICIARY IDENTIFIER (MBI) LIKE A CREDIT CARD


In 2018, CMS replaced Social Security-based Medicare numbers with new Medicare Beneficiary Identifiers (MBIs) specifically to reduce identity theft. Your MBI is the 11-character alphanumeric number on your red, white, and blue Medicare card. It is as sensitive as your Social Security Number.




NEVER give your MBI to: Anyone who calls you unsolicited — even if they claim to be from Medicare, CMS, or a federal agency. CMS does not call beneficiaries to ask for your Medicare number. This is always a fraud attempt.



Do not carry your physical Medicare card unnecessarily. Photograph it and store the image securely, or memorize the number.


Never provide your MBI in exchange for a "free" health screening, gift card, or equipment offer.


Verify any provider requesting your MBI is the one actually rendering care to you that day.


STEP 4: KNOW THE MOST COMMON MEDICARE SCAMS TARGETING SENIORS


The following schemes are currently the most prevalent, according to the HHS OIG Fraud Prevention Hotline and the National Council on Aging (NCOA):


Medical Equipment Fraud: You are offered a "free" brace, wheelchair, CPAP device, or diabetic supplies in exchange for your Medicare number. The company bills Medicare for high-cost equipment you may receive, not need, or never receive at all.

Genetic Testing Scams: You are approached at a health fair, pharmacy, or by phone offering a "free" genetic cancer-screening swab. Your Medicare is billed thousands of dollars for testing that is medically unnecessary and may never be reviewed by a physician.

Telehealth Impersonation: A caller offers a free telehealth consultation, claims to be from your doctor's office or a Medicare-affiliated service, and bills for a consultation that never occurred or is medically unjustified.

Prescription Drug Billing Fraud: Your Medicare Part D plan is billed for medications that were never dispensed, were substituted with cheaper drugs, or were prescribed by a physician who never met you — often through pill mills or corrupt pharmacies.

Home Health Overbilling: A home health agency inflates hours of care or bills for services during periods when you were hospitalized or did not require in-home assistance.

COVID-19 and Vaccine Scams: Fraudsters offer fake COVID tests, vaccines, or treatments in exchange for Medicare information. Though the acute pandemic phase has passed, these schemes persist.


STEP 5: REPORT SUSPICIOUS ACTIVITY — YOUR REPORT SAVES REAL MONEY


Every beneficiary report to the HHS OIG or 1-800-MEDICARE contributes to a system that recovers billions annually. OIG estimates that enforcement generates $3-$7 for every $1 invested, and individual tips have triggered multi-million dollar investigations.


When you call to report fraud, have ready: the provider name and address, the date of the suspicious service, your Medicare number (for verification purposes only), and a description of what was billed versus what actually happened.


KEY CONTACT RESOURCES




Organization

Phone

Website

Purpose

1-800-MEDICARE

1-800-633-4227

medicare.gov

Report fraud; general benefit questions


HHS OIG Hotline

1-800-447-8477

oig.hhs.gov/fraud/report-fraud

Report Medicare & Medicaid fraud


Senior Medicare Patrol (SMP)

1-877-808-2468

smpresource.org

Free counseling; help reviewing MSNs


MyMedicare.gov

—

medicare.gov/account/login

Real-time claims monitoring


FTC Identity Theft

1-877-438-4338

identitytheft.gov

If your Medicare ID is stolen/misused


SHIP (State Health Insurance Assistance)

Varies by state

shiphelp.org

Free local Medicare counseling


NCOA BenefitsCheckUp

—

benefitscheckup.org

Verify benefits and avoid overpayment



YOUR PERSONAL FRAUD PREVENTION CHECKLIST


Do these actions regularly to protect your Medicare benefits:


Monthly: Log into MyMedicare.gov and review all new claims.


Quarterly: Read your Medicare Summary Notice or Explanation of Benefits line by line.


Immediately: Report any charge you do not recognize by calling 1-800-MEDICARE.


Always: Refuse to give your Medicare number to anyone who contacts you unsolicited.


Annually: Contact your State Health Insurance Assistance Program (SHIP) for a free benefits review.


After any hospitalization: Review your Medicare records for any services billed during your stay that you did not receive.


If approached for free equipment or screenings: Ask your personal physician first — legitimate providers do not solicit through cold calls or health fairs.





Prepared as a companion to: "Trillion-Dollar Drain: How Fraud, Waste, and Abuse Are Hollowing Out America's Medicaid and Medicare Programs" | February 2026

This guide is for educational purposes. For personalized guidance, contact your SHIP counselor or a licensed Medicare advisor.




VERIFIED SOURCES AND FORMAL CITATIONS

1. OpenTheBooks — Medicaid Data Analysis, February 2026

Andrzejewski, A. (2026, February 21). Medicaid Data Dump: Billing Codes Explode Up to 10,000%. OpenTheBooks. https://www.openthebooks.com/medicaid-data-dump-billing-codes-explode/


2. HHS Open Payments / Medicaid Data Release

U.S. Department of Health and Human Services. (2026). Medicaid Payment Data 2018–2024 [Dataset]. HHS Open Data. https://data.cms.gov/


3. CBO — Federal Health Spending Projections

Congressional Budget Office. (2024). The Budget and Economic Outlook: 2024 to 2034. U.S. Government Publishing Office. https://www.cbo.gov/publication/59946


4. HHS OIG — Medicaid Improper Payments FY 2023

U.S. Department of Health and Human Services, Office of Inspector General. (2023). Medicaid Program Integrity: Improper Payments in FY 2023. https://oig.hhs.gov/reports-and-publications/workplan/


5. CMS CERT — Medicare Improper Payment Rate FY 2023

Centers for Medicare & Medicaid Services. (2023). Medicare FFS Improper Payments: Comprehensive Error Rate Testing (CERT) Report. https://www.cms.gov/data-research/monitoring-programs/medicare-ffs-compliance-programs/cert


6. DOJ Health Care Fraud Enforcement Actions, FY 2023

U.S. Department of Justice. (2023, August). Justice Department Charges 193 Defendants in $2.75 Billion Health Care Fraud Takedown. DOJ Press Release. https://www.justice.gov/opa/pr/justice-department-charges-193-defendants-275-billion-health-care-fraud-takedown


7. GAO — High-Risk Series: Medicare and Medicaid

U.S. Government Accountability Office. (2025, February). High-Risk Series: Medicare and Medicaid Programs (GAO-25-106900). https://www.gao.gov/highrisk/overview


8. GAO — Medicaid Managed Care Oversight

U.S. Government Accountability Office. (2022). Medicaid Managed Care: CMS Should Ensure States Have Information Needed to Oversee Supplemental Payments (GAO-22-104422). https://www.gao.gov/products/gao-22-104422


9. OIG — Medicaid Personal Care Services Safeguards

U.S. Department of Health and Human Services, Office of Inspector General. (2022). Medicaid Personal Care Services: States Lack Adequate Safeguards to Prevent Improper Payments (OEI-07-20-00051). https://oig.hhs.gov/oei/reports/OEI-07-20-00051.asp


10. New York State Comptroller — CDPAP Audit Reports

New York State Office of the State Comptroller. (2023). Audit of the Consumer Directed Personal Assistance Program. https://www.osc.ny.gov/state-agencies/audits/


11. California State Auditor — LA Dept. Mental Health Medicaid Billing

California State Auditor. (2023). Los Angeles County Department of Mental Health: Inadequate Documentation of Medicaid-Billable Services. Report 2022-106. https://www.auditor.ca.gov/reports/


12. Senate Finance Committee — Telehealth Fraud Investigation

U.S. Senate Committee on Finance. (2024). Telehealth Fraud Investigation: Findings and Recommendations (Bipartisan Staff Report). https://www.finance.senate.gov/


13. DOJ — Nationwide Telehealth Fraud Scheme Charges, 2023

U.S. Department of Justice. (2023). Federal Government Charges Defendants in $1.5 Billion Telehealth and Durable Medical Equipment Fraud Schemes. https://www.justice.gov/opa/


14. Centene Corporation Settlement — DOJ, 2023

U.S. Department of Justice. (2023). Centene Agrees to Pay $165 Million to Resolve Medicaid Pharmacy Billing Allegations. https://www.justice.gov/opa/pr/centene-agrees-pay-165-million-resolve-medicaid-pharmacy-billing-allegations


15. HHS OIG — Return on Investment in Healthcare Fraud Enforcement

U.S. Department of Health and Human Services, Office of Inspector General. (2024). OIG Annual Report: Savings, Recoveries and Return on Investment. https://oig.hhs.gov/reports-and-publications/oas/cms.asp


16. 21st Century Cures Act — Electronic Visit Verification Mandate

21st Century Cures Act, Pub. L. No. 114-255, § 12006, 130 Stat. 1033 (2016). Electronic Visit Verification Requirements for Medicaid Personal Care and Home Health Services. https://www.congress.gov/bill/114th-congress/house-bill/34


17. CMS — Electronic Visit Verification Final Rule

Centers for Medicare & Medicaid Services. (2020). Electronic Visit Verification: State Implementation, Best Practices, and CMS Guidance. https://www.medicaid.gov/medicaid/home-community-based-services/guidance/electronic-visit-verification/index.html


18. OpenTheBooks — CMS Staff and Salary Data, 2024

OpenTheBooks. (2024). Centers for Medicare & Medicaid Services: Federal Employee Salary Database. https://www.openthebooks.com/federal-employees/


NOTE: This article reflects publicly available data, government reports, and court records as of February 21, 2026. All figures cited are drawn from official government sources, court filings, and verified watchdog organizations. Readers are encouraged to consult primary sources directly. URLs provided link to official government and organizational websites.