Los Angeles County Mental Health Department officials charged more than $8 billion to Medicaid between 2018 and 2024, making that local California agency the biggest filer in the nation, according to a deep-dive analysis by Open the Books (OTB) of 270 million claims filed during those years.

Close behind, as the second biggest filer of Medicaid charges during the seven-year period, was the Latham, New York-based Public Partnership LLC with nearly $7.2 billion in claims. Public Partnership LLC specializes in helping Medicaid recipients living at home to get employee status for their caregivers and to manage funding for their compensation.

Third on the list is Tempus Unlimited, Inc. of Stoughton, Massachusetts with more than $6.6 billion. Tempus describes itself as providing “a continuum of community-based services that support the efforts of children and adults with disabilities to live as independently as possible.”

The top three claim filers were among 16 identified by OTB as receiving $2 billion or more in taxpayer-funded payments from Medicaid based on the federal health program’s exceedingly complex coding system for authorized goods and services. There are hundreds of billing codes in the system, but more than half of all claims filed come under the top 25 most frequently used codes, according to the organization.

As an Illinois-based nonprofit government spending watchdog, OTB has since its founding in 2008 used the federal Freedom of Information Act, similar state and local laws, and much costly litigation to assemble and make public via the internet “the largest private database of public spending in human history. Ten billion points of data that includes all federal salaries, line-by-line spending by the feds, all 50 state ‘checkbooks’ — their own line-by-line spending each year — plus millions of state-level salaries and pension funds, and spending across more than 17,000 municipalities.”

The OTB goal is to have “every dime online, in real time” to ensure the maximum transparency in government spending and enable citizens to evaluate programs and policies based on actual costs and productivity.

The 270 million documents obtained by OTB were released earlier this month by the U.S. Department of Health and Human Services (HHS), which oversees the Medicaid system through its Centers for Medicare and Medicaid (CMS). The total value of all the claims documented exceeded $1 trillion.

“Payment amounts generally increased over time, with a notable bump starting in 2020 in response to COVID-related spending and increased enrollment due to economic hardship caused by government-imposed economic shutdowns,” OTB explained.

As expected, given their population and demographics, the top 10 states for total Medicaid claim payments during the seven-year period were topped by New York with more than $142 million in payments for 15.7 million claims, followed by California at $127 million in total Medicaid payments. Notably, the California total consisted of nearly 30.8 million claims — more than twice as many claims as New York.

Texas was third, seeing $64.5 million in payments prompted by 12.8 million claims. Coming in fourth with $55.3 million and 6.7 million claims was Massachusetts, followed by New Jersey at $46.4 million and almost 5.8 million claims. Michigan, Ohio, North Carolina, Florida, and Pennsylvania rounded out the top 10.

The most frequently used claim code during the period was T1019, which covers expenses related to in-home care, a category that includes personal care services as part of an individualized care plan as an alternative to nursing home-based care and services. For the 2018-2024 period, the T1019 claim code was used for nearly $123 billion in tax-funded payments, compared to $9.6 billion in 2018, an increase of almost 144%.

The total payments for T1019 were more than double the second most-frequently used claims code, T1015 for clinic visits, which compiled more than $49 million in payments.

“T1019 is not the only billing code with explosive growth from 2018 to 2024, although it is the code with the highest amount paid out in that time. Twenty-two other codes saw anywhere from 200 percent to over 10,000 percent increases. Eight codes had over 500 percent more payments,” according to OTB.

Pennsylvania’s personal assistance services code, W1793, was the biggest increaser, skyrocketing 10,283%, from $5.6 million to $583 million from 2018 to 2024.

There were 6,535 CMS employees in 2024, including 5,785 who are paid between $100,000 and $199,000 annually, with the vast majority living in the National Capital Region. The total payroll costs of $918 million for CMS do not include the federally funded costs of health insurance and retirement benefits. Such benefits typically add about 30% to the salary expense of an individual employee.