Medicare Fraud Risk by State
6,704 Medicare Part D prescribers flagged as high-risk across 52 states, generating $3.02B in drug costs. Risk scores are statistical indicators based on prescribing pattern analysis — not allegations of fraud.
Data: CMS Medicare Part D, 2023 (most current available) · Updated March 2026
| State | High-Risk Providers | Flagged Cost |
|---|---|---|
| California | 618 | $484.1M |
| Florida | 359 | $174.8M |
| North Carolina | 346 | $189.8M |
| New York | 344 | $320.0M |
| Pennsylvania | 340 | $174.0M |
| Ohio | 315 | $69.1M |
| Tennessee | 270 | $82.8M |
| Arizona | 257 | $35.5M |
| Michigan | 252 | $86.7M |
| Indiana | 241 | $58.5M |
| Illinois | 217 | $77.2M |
| Colorado | 187 | $40.5M |
| Texas | 177 | $125.6M |
| Maryland | 177 | $37.4M |
| Washington | 162 | $36.0M |
| New Jersey | 159 | $72.4M |
| Wisconsin | 156 | $20.7M |
| Virginia | 150 | $57.2M |
| Massachusetts | 140 | $66.0M |
| Minnesota | 133 | $21.9M |
| Georgia | 118 | $72.4M |
| Mississippi | 102 | $56.3M |
| South Carolina | 94 | $44.5M |
| Missouri | 94 | $93.5M |
| Louisiana | 93 | $60.7M |
| Kansas | 92 | $30.7M |
| Connecticut | 91 | $60.2M |
| Utah | 91 | $14.0M |
| Alabama | 83 | $54.4M |
| Oregon | 83 | $20.1M |
| Kentucky | 80 | $35.9M |
| Oklahoma | 77 | $92.5M |
| Nevada | 74 | $20.1M |
| Arkansas | 61 | $12.4M |
| Idaho | 60 | $13.7M |
| Iowa | 59 | $14.3M |
| Nebraska | 43 | $14.6M |
| Delaware | 36 | $8.2M |
| New Hampshire | 36 | $15.8M |
| South Dakota | 32 | $3.0M |
| Maine | 27 | $6.3M |
| New Mexico | 25 | $10.1M |
| Montana | 24 | $2.0M |
| West Virginia | 21 | $6.1M |
| Hawaii | 20 | $1.3M |
| Wyoming | 19 | $4.2M |
| North Dakota | 15 | $2.8M |
| Alaska | 14 | $1.9M |
| Rhode Island | 14 | $10.0M |
| District of Columbia | 9 | $2.1M |
| Vermont | 9 | $3.2M |
| Puerto Rico | 8 | $6.4M |
About This Data
These providers were flagged by our 10-component risk scoring model which analyzes prescribing patterns including opioid rates, brand-name preference, cost outliers, dangerous drug combinations, and comparison to specialty peers. Providers scoring above our high-risk threshold are included.
High risk scores indicate statistical anomalies in prescribing patterns. They may reflect legitimate clinical specialization, institutional billing patterns, or data limitations — not necessarily fraud. See our methodology for details.