National Transparency Scorecard

A state-by-state look at where healthcare dollars leak — and who ends up paying for it.

The National Transparency Scorecard reframes healthcare waste, over-utilization, and administrative complexity from isolated fraud headlines into something you can actually see: a map of how hidden leakage flows through premiums, Medicare costs, Social Security pressure, and the long-term financial stability of families across the country.

This is not a list of accusations. It's an educational framework for taxpayers, seniors, operators, and policymakers — a way to understand where the estimated $760 to $935 billion the U.S. loses every year to waste — including fraud and abuse — is concentrated, and why it reaches people living on fixed incomes and small businesses trying to make payroll.

What the Scorecard Measures

The Scorecard groups states by their estimated systemic leakage — the share of healthcare spending lost to administrative bloat, over-utilization, manufactured necessity, reimbursement inefficiency, and non-clinical waste. A higher number isn't a verdict on a state; it's a signal of where the pressure, and the opportunity for reform, is greatest.

The 2026 State Leakage Map

Each state is evaluated across the same lens — estimated annual loss, leakage rate, primary category, and reform opportunity — as a directional picture, not an audit. States are ranked by estimated annual dollar loss. The Leakage Rate Band is a separate measure of the share of spending lost, so a smaller state can carry a higher band than a larger one.

Rank State Leakage Rate Band Estimated Annual Loss Primary Leakage Category
1 California Elevated ~$35–42B est. Hospice utilization and managed-care administrative leakage
2 New York Elevated ~$26–32B est. Consumer-directed personal assistance and inpatient billing complexity
3 Florida Very elevated ~$20–24B est. Medicare Advantage coding intensity and home health utilization
4 Texas Very elevated ~$18–22B est. Cardiac procedure utilization and durable medical equipment spending
5 Michigan Very elevated ~$12–16B est. Laboratory testing and diagnostic imaging over-utilization
6 Pennsylvania Elevated ~$12–15B est. Skilled nursing and therapy-service utilization
7 Illinois Elevated ~$11–14B est. Pharmaceutical rebate and benefit-management complexity
8 New Jersey Elevated ~$10–13B est. Wound-care products and skin-substitute utilization
9 Ohio Elevated ~$9–12B est. Pain-management utilization and medical-necessity variation
10 North Carolina Elevated ~$8–11B est. Laboratory testing and cardiac procedure utilization
11 Massachusetts Moderate ~$8–11B est. Specialist pricing and administrative complexity
12 Georgia Moderate ~$8–10B est. Telehealth utilization and rural health reimbursement variation
13 Tennessee Very elevated ~$7–10B est. Behavioral health and recovery-service contracting
14 Indiana Elevated ~$6–9B est. Hospital market concentration and pricing variation
15 Arizona Moderate ~$6–8B est. Medicare Advantage payment and senior-care utilization
16 Missouri Moderate ~$6–8B est. Medicaid transportation and durable medical equipment spending
17 Virginia Moderate ~$6–8B est. Government-contractor and administrative billing complexity
18 Maryland Moderate ~$5–7B est. Global budget reimbursement and hospital revenue complexity
19 Colorado Moderate ~$5–7B est. Large health-system pricing variation
20 Wisconsin Moderate ~$5–7B est. Value-based care measurement and savings attribution
21 Washington Lower ~$5–7B est. Managed-care organization administrative leakage
22 Alabama Elevated ~$4–6B est. Post-acute care utilization
23 Louisiana Elevated ~$4–6B est. Outpatient surgical utilization
24 South Carolina Elevated ~$4–6B est. Diagnostic testing utilization
25 Kentucky Elevated ~$4–6B est. Opioid-treatment oversight and compliance variation
26 Connecticut Moderate ~$4–6B est. Specialist coding and reimbursement variation
27 Minnesota Lower ~$4–6B est. Medicare plan selection and risk-adjustment variation
28 Oklahoma Elevated ~$3–5B est. Tribal health integration and reimbursement complexity
29 Oregon Lower ~$3–5B est. Coordinated-care organization administration
30 Nevada Moderate ~$3–4B est. Emergency-room utilization and tourism-related demand
31 Iowa Moderate ~$3–4B est. Managed-care administrative complexity
32 Mississippi Elevated ~$2–4B est. Chronic-disease management and billing variation
33 Arkansas Elevated ~$2–4B est. Premium growth and healthcare spending inefficiency
34 Kansas Moderate ~$2–4B est. Rural-provider reimbursement leakage
35 New Mexico Elevated ~$2–3B est. Behavioral-health contracting and oversight
36 West Virginia Elevated ~$2–3B est. Pulmonary rehabilitation and occupational health utilization
37 Nebraska Moderate ~$2–3B est. Physician-owned hospital utilization
38 Utah Lower ~$2–3B est. Administrative costs relative to utilization
39 Hawaii Lower ~$2–3B est. Geographic and cost-of-living adjustments
40 Maine Moderate ~$1–2B est. Older-adult care-service utilization
41 Rhode Island Moderate ~$1–2B est. Managed Medicaid administration
42 Montana Moderate ~$1–2B est. Critical-access hospital reimbursement and utilization
43 Delaware Moderate ~$1–2B est. Corporate and administrative billing complexity
44 South Dakota Moderate ~$1–2B est. Institutional post-acute care utilization
45 Idaho Lower ~$1–2B est. Private-pay and self-funded market leakage
46 New Hampshire Lower ~$1–2B est. Hospital pricing variation
47 Alaska Lower ~$1–2B est. Remote-care delivery and transportation costs
48 Vermont Moderate ~$0.5–1.5B est. Statewide payment-model administrative friction
49 North Dakota Lower ~$0.5–1.5B est. Employer health-plan and occupational coverage costs
50 Wyoming Moderate ~$0.5–1B est. Premium costs and rural-market inefficiency

Methodology and Limitations

The National Transparency Scorecard is an editorial and analytical framework developed by Sentinel Media for education and discussion. Figures are directional estimates built from publicly reported healthcare-waste research and Sentinel's own modeling. They are not official government findings, audited financial data, or legal conclusions, and they are not allegations of wrongdoing against any specific organization, provider, or individual. Where the Scorecard names a category — such as imaging or post-acute care — it refers to system-level spending patterns, not to any identified company or person.

How states are ranked: by estimated annual loss, largest first. The leakage rate band shows how elevated each state’s leakage is relative to its spending.

Source for the national figure: the $760 billion to $935 billion annual range comes from Shrank WH, Rogstad TL, Parekh N. “Waste in the US Health Care System: Estimated Costs and Potential for Savings.” JAMA. 2019;322(15):1501–1509.