— Duncan Burns (@DuncanBurnsMA) February 16, 2026
"TL;DR" version: Massachusetts doesn't have Medicaid fraud — it has something worse. The government built the extraction into the law, made itself exempt from audit, and the budget doubled to $61B while the people who'd have to fix it are the ones cashing the checks. DOGE and HHS just open-sourced the largest Medicaid dataset in agency history — 6.47 million rows of provider-level claims from 2018 through 2024. For the first time, anyone can see what every Medicaid provider in America billed, code by code, dollar by dollar.
Across the country, people are diving in and finding exactly what you'd expect — providers overbilling, questionable entities, patterns that scream fraud. That's the system failing. That's what audits are supposed to catch.
Massachusetts is different. And I think what's happening here is worse.
I want to be clear about something first.
I'm no @DataRepublican. She's a national treasure and should be protected at all costs. What she's done at the federal level — building the tools that let citizens actually trace where the money goes, mapping the grant IDs nobody could search, connecting the dots between lawmakers and the NGO boards they sit on — that's generational work. She changed the equation between citizens and their government, and she paid a real personal price for it. Her motto — "data does not equal transparency" — should be tattooed on every government building in America.
What I've done is much smaller. I took the same T-MSIS data and focused it on one state — Massachusetts — and cross-referenced it against state vendor payments (CTHRU), 31,000+ campaign finance records (OCPF), lobbying registrations, IRS 990s, and corporate filings to build a single interactive dashboard that shows the full picture of how money moves through our state.
The dashboard is public and every number comes from public records:
Every other state has a fraud problem. Massachusetts has a system.
Most states getting attention right now have a provider problem — shady operators gaming the billing system. You find the fraud, you prosecute it, you recover the money. The system failed, and audits fix it.
Massachusetts doesn't have that problem. The personal care code that's blowing up nationally — T1019 — is actually billed below the national average here. 0.78×. Tempus Unlimited, a private nonprofit, processes $6.13 billion in personal care at below-market rates. Forty thousand PCA workers. Efficient. Transparent. It proves the model works.
So where's the money?
It's in the codes nobody's talking about — billed through state agencies, not private companies.
T2016 — Residential habilitation (group home daily rate) Massachusetts: $2,109/day Alabama: $113/day Same federal program. Same HCPCS code. Same CMS rules. 18.7× the national average.
G0156 — Home health aide visit Massachusetts: $320/visit National average: $8/visit 40× the national average.
S5140 — Adult foster care daily rate Massachusetts: $220/day National: $106/day $599 million through a for-profit Delaware corporation (Caregiver Homes / Seniorlink Inc d/b/a Careforth) whose new CEO previously ran Medicaid operations across 21 states at Molina Healthcare. He knows the billing system inside and out. Zero political donations on file. No public financial disclosures.
Combined, these codes represent over $10 billion. Through state-run agencies.
The 14-NPI Shell Game
The Department of Developmental Services (DDS) is one state agency. One mission. One budget.
It uses fourteen separate National Provider Identifiers to bill CMS.
Combined total: $8.2 billion.
No other state in America fragments a single department's billing like this. You'd have to know to look for all 14 NPIs, manually combine them across a 6.47-million-row dataset, and add them up.
Nobody does that. That's the point.
I did it. The dashboard maps all 14.
It's Not Fraud. It's Policy.
This is what separates Massachusetts from every other state people are investigating right now.
Other states have providers gaming the system from outside. Massachusetts built the extraction into the law itself.
Chapter 257 of Massachusetts law requires the state to reimburse nonprofits at rates that cover their "actual costs." Sounds reasonable. Here's how it actually works:
Nonprofits report their own costs. Those costs include CEO compensation — $797,000 at Seven Hills, $696,000 at Advocates Inc., $500K-$800K across the board. Those costs include lobbying expenditures — money spent lobbying for higher rates gets counted as a cost, which then gets reimbursed at a higher rate.
The state auto-converts those self-reported costs into Medicaid billing rates. No external review. No independent audit. No cap.
Then they bill CMS at those self-set rates, and the federal government matches it.
It's not fraud. It's law.
The Pay-to-Play Loop
This is where it becomes a closed system.
David Jordan, CEO of Seven Hills Foundation. Compensation: $797,000. He also chairs ADDP — the trade association that lobbies Beacon Hill for Ch.257 rate increases. ADDP spends $246,000 per year lobbying for rate increases that directly benefit... Seven Hills Foundation. And David Jordan.
Eric Dickson, CEO of UMass Memorial Health. Compensation: $3.9 million. He is the only hospital CEO in America who is also a registered lobbyist. He personally lobbies the legislators who control his hospital's funding.
Mass General Brigham spent $3.25 million on lobbying. From a standing start with zero MCO presence, they were awarded a $1.4 billion managed care contract. No competitive bid. That's a 430× return on investment.
Kate Walsh was CEO of Boston Medical Center. She left to become EOHHS Secretary — the person who runs the $27 billion state health agency. During her time, BMC's managed care plan grew 71%. Then she went back to the private sector.
1199SEIU — 40,000 home care workers paying $4-5 per paycheck in mandatory dues. That funds a $14.09 million PAC that donates exclusively to Democratic legislators — the same legislators who vote on Ch.257 rate increases. Workers earn $14-22/hr. The rate increases go to CEO comp. The workers never see the money.
All of this is documented in 31,000+ OCPF records in the dashboard.
Fraud Detection: By Design, It Doesn't Exist
Massachusetts Medicaid fraud recovery rate: 0.063% Louisiana: 0.90%
18 investigators for 2.2 million recipients.
No IRS cross-check on income reported to MassHealth. No SSA cross-check. No interstate database. The Department of Transitional Assistance, MassHealth, and the Department of Revenue don't share data with each other. The same person can report $15,000 income to one agency and $50,000 to another. Zero automated detection.
In November 2024, Governor Healey refused to share SNAP data with the USDA when the federal government asked for it.
Massachusetts is dead last nationally in fraud detection. And that's not an accident. When the people running the system benefit from the system, the last thing they want is someone looking at the numbers.
The Audit They're Blocking
In November 2024, 72% of Massachusetts voters approved Question 1 — authorizing the State Auditor to audit the Legislature.
Fifteen months later, Speaker Ron Mariano and Senate President Karen Spilka have not produced a single document.
Spilka compared the State Auditor to Trump for trying to enforce a law the voters passed. Mariano called it "unconstitutional."
Massachusetts is the only state in America where the Governor, the Legislature, AND the Judiciary are all exempt from public records law. Committee votes can be secret. Conference committees meet behind closed doors. Bills die in the middle of the night with no recorded roll calls.
Here's What I Think
Unlike other states where DOGE and citizen investigators are finding fraud — real fraud, prosecutable fraud, people who should be in prison — I don't think a Massachusetts audit would find fraud in the traditional sense.
What it would find is something more corrosive: a government apparatus that built the extraction into the law and then made itself exempt from review.
The budget doubled from $28 billion to $61 billion in seven years. Worker wages went up 17%. CEO compensation sits at $500,000-$800,000. The pay-to-play cycle is self-reinforcing — unions fund legislators who set rates that fund nonprofits that fund trade groups that fund lobbyists who fund legislators.
Every dollar is traceable. Every connection is documented. Every number in the dashboard comes from a public record. And nothing changes — because the people who'd have to change it are the ones who benefit.
The national T-MSIS data dump is a watershed moment. Citizens can finally see what was hidden. But Massachusetts proves something darker: even when the data is public, the system doesn't care. Because the fraud isn't hidden. It's legal. It's policy. And it's impoverishing those of us in the middle while enriching the connected few at the top.
They control every dollar. Nobody audits them. They don't care. Why should they? Your cost to live in Massachusetts is never going down.
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