National Transparency Scorecard

The live forensic breakdown of healthcare leakage across America.

The National Transparency Scorecard (NTS) transforms healthcare waste, abuse, over-utilization, and systemic inefficiency into a state-by-state transparency framework for taxpayers, seniors, operators, and policymakers.

This is not simply a fraud discussion. It is an economic map showing how hidden healthcare leakage impacts premiums, Medicare costs, Social Security pressure, and long-term financial stability across the United States.

$338 Billion Lost Every Year

Based on Sentinel Media’s forensic framework, the estimated annual loss tied to healthcare waste, administrative complexity, over-utilization, and systemic leakage exceeds $338 billion annually across all 50 states.

That loss affects:

Medicare premiums
Social Security adjustments
taxpayer burden
healthcare affordability
small business costs
patient outcomes
operational sustainability

The NTS reframes the conversation from isolated fraud cases into a nationwide infrastructure crisis.

The 2026 State-by-State Leakage Map

The “Systemic Leakage Rate” evaluates the percentage of healthcare dollars lost through:

administrative bloat
over-utilization
manufactured necessity
reimbursement inefficiencies
non-clinical waste
overbilling pressure

Each state is evaluated through a transparency lens to identify:

estimated annual loss
operational risk
primary leakage source
reimbursement pressure patterns
governance opportunity

  

    
        Rank
        State
        Systemic Leakage
        Estimated Annual Loss
        Primary “Plague” Source
      


    1Florida31%$22.4 BillionMedicare Advantage "Upcoding" & HHA Fraud.
2Texas29%$19.8 BillionCardiac Optimization & DME Schemes.
3Michigan28%$14.1 BillionLab Over-utilization & Forensic Imaging Scams.
4Tennessee28%$8.4 BillionBehavioral Health & Recovery Broker Schemes.
5New York27%$29.2 BillionCDPAP Waste & Inpatient Over-billing.
6New Jersey27%$11.5 BillionWound Care "Skin Substitute" Inflation.
7California26%$38.7 BillionHospice Fraud & Managed Care Leakage.
8Ohio26%$10.2 BillionPain Management "Manufactured Necessity."
9Indiana26%$7.4 BillionMonopolistic Hospital Billing Practices.
10Pennsylvania25%$13.4 BillionSkilled Nursing Facility "Therapy" Padding.
11Illinois25%$12.3 BillionPharmaceutical Rebate Inefficiencies.
12North Carolina25%$9.1 BillionLab Testing & Cardiac Stent Volume Plays.
13Georgia24%$8.9 BillionTelehealth Abuse & Rural Health Inaccuracies.
14Arizona24%$7.1 BillionSenior Care "Advantage" Over-payments.
15Missouri24%$6.9 BillionMedicaid Transportation & DME Over-billing.
16Maryland23%$6.1 BillionGlobal Budget Revenue (GBR) Inefficiencies.
17Virginia23%$6.8 BillionGovernment Contractor Billing Padding.
18Massachusetts22%$9.5 Billion"Prestige" Billing Bloat & Admin Complexity.
19Washington21%$6.2 BillionManaged Care Organization (MCO) Leakage.
20Minnesota20%$5.3 BillionFavorable Selection in Private Medicare.
21Alabama26%$4.9 BillionPost-Acute Care Over-utilization.
22Louisiana27%$5.1 BillionOutpatient Surgery "Optimization."
23South Carolina25%$4.7 BillionDiagnostic Testing Density.
24Kentucky26%$4.8 BillionOpioid Clinic "Compliance" Failures.
25Nevada24%$3.2 BillionTourism-Based Emergency Room Inflation.
26Colorado22%$5.8 BillionLarge Health System Pricing Failures.
27Oregon21%$4.1 BillionCoordinated Care Organization (CCO) Waste.
28Wisconsin23%$5.9 BillionValue-Based Care "Ghost" Savings.
29Oklahoma25%$3.9 BillionTribal Health Integration Inefficiencies.
30Mississippi26%$2.8 BillionChronic Disease Management Over-billing.
31Arkansas27%$3.1 BillionFastest Rising Premiums due to Waste.
32Utah19%$2.4 BillionLow Utilization but High Admin Cost.
33Kansas24%$3.0 BillionRural Provider Reimbursement Leakage.
34Iowa22%$3.2 BillionMCO Administrative Bloat.
35Connecticut23%$4.6 BillionHigh-End Specialist Coding Inflation.
36New Mexico25%$2.3 BillionBehavioral Health Contracting Fraud.
37West Virginia27%$2.6 BillionBlack Lung & Pulmonary Rehab Scams.
38Nebraska23%$2.1 BillionPhysician-Owned Hospital Over-utilization.
39Idaho20%$1.8 BillionPrivate Pay/Self-Funded Market Leaks.
40Hawaii21%$2.2 BillionGeographic Cost-of-Living Padding.
41Maine24%$1.9 BillionElderly Care Services Over-billing.
42New Hampshire21%$1.7 BillionHigh Hospital Pricing Failures.
43Rhode Island22%$1.4 BillionManaged Medicaid Inefficiencies.
44Montana23%$1.3 BillionCritical Access Hospital Over-billing.
45Delaware24%$1.2 BillionCorporate Billing Complexities.
46South Dakota22%$1.1 BillionInstitutional Post-Acute Waste.
47North Dakota21%$0.9 BillionEnergy-Sector Health Plan Padding.
48Vermont22%$0.8 BillionSingle-Payer Administrative Friction.
49Wyoming24%$0.7 BillionHigh Premium Inefficiencies.
50Alaska21%$1.2 BillionRemote Care & Transportation Scams.


  

Rank	State	Systemic Leakage	Estimated Annual Loss	Primary “Plague” Source
1	Florida	31%	$22.4 Billion	Medicare Advantage "Upcoding" & HHA Fraud.
2	Texas	29%	$19.8 Billion	Cardiac Optimization & DME Schemes.
3	Michigan	28%	$14.1 Billion	Lab Over-utilization & Forensic Imaging Scams.
4	Tennessee	28%	$8.4 Billion	Behavioral Health & Recovery Broker Schemes.
5	New York	27%	$29.2 Billion	CDPAP Waste & Inpatient Over-billing.
6	New Jersey	27%	$11.5 Billion	Wound Care "Skin Substitute" Inflation.
7	California	26%	$38.7 Billion	Hospice Fraud & Managed Care Leakage.
8	Ohio	26%	$10.2 Billion	Pain Management "Manufactured Necessity."
9	Indiana	26%	$7.4 Billion	Monopolistic Hospital Billing Practices.
10	Pennsylvania	25%	$13.4 Billion	Skilled Nursing Facility "Therapy" Padding.
11	Illinois	25%	$12.3 Billion	Pharmaceutical Rebate Inefficiencies.
12	North Carolina	25%	$9.1 Billion	Lab Testing & Cardiac Stent Volume Plays.
13	Georgia	24%	$8.9 Billion	Telehealth Abuse & Rural Health Inaccuracies.
14	Arizona	24%	$7.1 Billion	Senior Care "Advantage" Over-payments.
15	Missouri	24%	$6.9 Billion	Medicaid Transportation & DME Over-billing.
16	Maryland	23%	$6.1 Billion	Global Budget Revenue (GBR) Inefficiencies.
17	Virginia	23%	$6.8 Billion	Government Contractor Billing Padding.
18	Massachusetts	22%	$9.5 Billion	"Prestige" Billing Bloat & Admin Complexity.
19	Washington	21%	$6.2 Billion	Managed Care Organization (MCO) Leakage.
20	Minnesota	20%	$5.3 Billion	Favorable Selection in Private Medicare.
21	Alabama	26%	$4.9 Billion	Post-Acute Care Over-utilization.
22	Louisiana	27%	$5.1 Billion	Outpatient Surgery "Optimization."
23	South Carolina	25%	$4.7 Billion	Diagnostic Testing Density.
24	Kentucky	26%	$4.8 Billion	Opioid Clinic "Compliance" Failures.
25	Nevada	24%	$3.2 Billion	Tourism-Based Emergency Room Inflation.
26	Colorado	22%	$5.8 Billion	Large Health System Pricing Failures.
27	Oregon	21%	$4.1 Billion	Coordinated Care Organization (CCO) Waste.
28	Wisconsin	23%	$5.9 Billion	Value-Based Care "Ghost" Savings.
29	Oklahoma	25%	$3.9 Billion	Tribal Health Integration Inefficiencies.
30	Mississippi	26%	$2.8 Billion	Chronic Disease Management Over-billing.
31	Arkansas	27%	$3.1 Billion	Fastest Rising Premiums due to Waste.
32	Utah	19%	$2.4 Billion	Low Utilization but High Admin Cost.
33	Kansas	24%	$3.0 Billion	Rural Provider Reimbursement Leakage.
34	Iowa	22%	$3.2 Billion	MCO Administrative Bloat.
35	Connecticut	23%	$4.6 Billion	High-End Specialist Coding Inflation.
36	New Mexico	25%	$2.3 Billion	Behavioral Health Contracting Fraud.
37	West Virginia	27%	$2.6 Billion	Black Lung & Pulmonary Rehab Scams.
38	Nebraska	23%	$2.1 Billion	Physician-Owned Hospital Over-utilization.
39	Idaho	20%	$1.8 Billion	Private Pay/Self-Funded Market Leaks.
40	Hawaii	21%	$2.2 Billion	Geographic Cost-of-Living Padding.
41	Maine	24%	$1.9 Billion	Elderly Care Services Over-billing.
42	New Hampshire	21%	$1.7 Billion	High Hospital Pricing Failures.
43	Rhode Island	22%	$1.4 Billion	Managed Medicaid Inefficiencies.
44	Montana	23%	$1.3 Billion	Critical Access Hospital Over-billing.
45	Delaware	24%	$1.2 Billion	Corporate Billing Complexities.
46	South Dakota	22%	$1.1 Billion	Institutional Post-Acute Waste.
47	North Dakota	21%	$0.9 Billion	Energy-Sector Health Plan Padding.
48	Vermont	22%	$0.8 Billion	Single-Payer Administrative Friction.
49	Wyoming	24%	$0.7 Billion	High Premium Inefficiencies.
50	Alaska	21%	$1.2 Billion	Remote Care & Transportation Scams.

The National Transparency Scorecard is an editorial and analytical framework developed by Sentinel Media for educational and discussion purposes. Estimates, rankings, and interpretations are derived from publicly discussed healthcare waste trends, industry reporting, and internal analytical modeling and should not be interpreted as official government findings, audited financial data, or legal conclusions.

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