Desk
Financial distress
Hospital closures, bankruptcies, and debt cycles — the balance-sheet signals that precede a facility going dark.
38 studies on this desk
- Two federal exclusion lists, and they don't match: the OIG LEIE–SAM.gov overlap
Only 47.9% of NPI-identified providers under an active federal exclusion — 3,747 of 7,827 — appear on both U.S. federal exclusion lists, the HHS-OIG LEIE and GSA SAM.gov. A SAM.gov-only screen misses 3,133 actively OIG-excluded providers, 45.5% of the LEIE. OIG LEIE release 2026-05-08; SAM.gov as of 2026-06-19.
2026-06-22 · 9 min - Barred, but still listed: excluded providers stay active in the provider directory
Of 6,150 providers barred from federal health programs by the OIG who appear in NPPES — the national provider identity registry — 6,123 (99.6%) are still listed as active. NPPES does not deactivate a National Provider Identifier when its holder is excluded, so the directory most credentialing checks resolve against shows them as ordinary.
2026-06-20 · 10 min - Medicaid Exclusion List Blind Spots: State Bars the Feds Miss
Of 4,949 providers with an active state Medicaid exclusion across the 13 state programs Fonteum ingests, 3,188 — 64.4% — have no record on the federal OIG LEIE. Adding the SAM.gov debarment list recovers only 191: 2,997 stay invisible to both federal lists. And 198 are barred across two or more states at once.
2026-06-19 · 10 min - Who Owns Hospitals? Every Ownership Change, Tracked (2026)
Across the 755 hospital ownership-change transactions on CMS's published file, 2016–2025, the ten most active buyers account for just 11.5% of them and 59.9% of all 461 buyers appear exactly once. America's hospitals change hands constantly — but no one is rolling them up.
2026-06-17 · 9 min - Who owns the medical industry: the Open Payments file nobody opens
CMS's Open Payments ownership file lists 4,591 stakes that 3,965 physicians held in medical companies in 2024, worth $1.34 billion. The median stake is $19,440, but the top 1% of records hold 62.3% of the value: most are token interests in physician groups, and the dollars sit in a handful of device-company stakes.
2026-06-17 · 9 min - The price-transparency enforcement funnel: 11,440 actions, 28 fines
Since January 2021, CMS has taken 11,440 hospital price-transparency enforcement actions against 4,975 hospitals. Almost none end in a fine: just 28 reached a civil monetary penalty, the only action that carries one. The rest are warnings, corrective-action requests, and — overwhelmingly — hospitals that fixed the problem and closed the case.
2026-06-16 · 9 min - The few drugs that drive most of Medicare's Part D bill, 2023
Medicare Part D paid $275.9 billion for 3,598 drugs in 2023. The 100 costliest — just 2.8% of the list — account for $176.2 billion, 63.8% of the bill. Ten drugs alone are a quarter of it, and 61.5% of priced drugs cost more per dose than a year earlier.
2026-06-16 · 10 min - Nursing Home Fines Are Getting Bigger: A Three-Year Trend
Across three years of CMS nursing-home enforcement — 13,764 fines totaling $459.3M — the size of the typical penalty more than doubled. The median fine rose from $8,193 in 2023 to $22,315 so far in 2026 — up 21% across the two complete years. The whole distribution shifted up, not a few outliers.
2026-06-16 · 8 min - Private Equity Nursing Homes: Who Owns America's Facilities
Of the 14,425 U.S. skilled nursing facilities in CMS's PECOS ownership file, only 28.1% are independent — owned by individuals or a single-facility entity. The other 71.9% disclose a multi-facility organization among their owners, and 52.3% belong to a group of 10 or more facilities.
2026-06-16 · 9 min - Where nursing-home penalties concentrate: a repeat-citation story, 2026
Between May 2023 and April 2026, CMS imposed $459.3M in civil money penalties and 2,513 payment denials on 6,884 nursing facilities. Enforcement concentrates: the 53.7% of penalized facilities cited more than once carry 80.1% of the fine dollars and 90.6% of the payment denials — the half cited once drew a fifth of the money.
2026-06-16 · 9 min - Corporate Integrity Agreement Tracker: Who Is Under One (2026)
Half of America's active federal health-care integrity agreements — 50.0% — sit in just five states. Of the 335 agreements in HHS-OIG's published registry, 114 are currently in effect, and California and Florida alone hold 35 of those active cases, 30.7% of the national total; the remaining 79 are spread across 27 other jurisdictions.
2026-06-16 · 8 min - The $8.5 billion nobody counts: research is most of industry's money
Every Open Payments study reads the same $3.31 billion general slice. But the largest kind of industry payment is research: $8.49 billion in 2024, 71% of all industry money on just 4.7% of records. And 98.9% of it goes to institutions, not individual physicians — paid out by a field one-third as broad.
2026-06-16 · 9 min - OIG Exclusion Check: The 2026 Excluded-Provider Landscape
At the July 14, 2026 audit cutoff, the OIG LEIE, SAM.gov, and 13 state Medicaid programs contained 10,824 NPI-identified providers barred from a public health program — yet the single most complete list, the OIG LEIE, named only 6,880 of them. Screen against that one source and 36.4% of excluded providers come back clean.
2026-06-15 · 11 min - Barred but order-eligible: excluded providers still cleared to order and refer in Medicare
In the June 15, 2026 study snapshot, 170 of 2,008,019 providers cleared to order and refer in Medicare carried an active exclusion or sanction, matched on NPI. Of those 170, 105 had stood for over a year. The result is a dated screening flag, not a current claim against any person.
2026-06-15 · 10 min - State Medicaid Exclusion Lists vs the Federal LEIE: The Gap
In the July 14, 2026 production observation, 3,188 of 4,949 NPI-identified providers excluded across 13 state Medicaid programs — 64.4% — carried no record on the federal OIG LEIE. Another 15,487 in-force state exclusion records had no NPI and could not be matched to the federal list by identifier.
2026-06-15 · 9 min - Barred but billable: excluded providers still enrolled in Medicare
19 providers barred from all federal health programs by the OIG still hold an active Medicare enrollment record in PECOS — out of 6,880 in-force NPI-identified federal exclusions. Most trace to a single refresh cycle's lag, but two have stood for over a year, one excluded since 2015.
2026-06-14 · 9 min - Industry payments to providers on the OIG exclusion list
In program year 2024, drug and device manufacturers reported $3.84 million in Open Payments to 294 physicians and other providers who now sit on the federal OIG exclusion list, spread across 3,055 separate transfers. A single category — debt forgiveness — accounts for $3.27 million of that total.
2026-06-14 · 10 min - DRG Code List with Medicare Payments and Volumes (2026)
Across all 540 MS-DRGs in the 2024 Medicare inpatient file, hospitals were paid an average of $15,166 per stay against $92,408 in billed charges — a 6.1× gap. Sepsis (DRG 871) was the highest-volume code at 577,119 discharges; CAR T-cell therapy (DRG 018) the costliest at $434,771 per stay.
2026-06-14 · 10 min - Same DRG, wildly different price: hospital charge variation, 2024
For the same Medicare DRG, hospitals bill wildly different amounts: across 219 high-volume codes in 2024, the 90th-percentile hospital charged a median of 3.8× what the 10th-percentile hospital charged for the identical stay. For sepsis — the most common code, billed by 2,661 hospitals — the spread is 4.4×.
2026-06-14 · 10 min - Same procedure, different price: Medicare Part B charge variation, 2024
For the same Medicare Part B procedure, in the same care setting, providers bill wildly different amounts: across 997 high-volume procedure-and-setting groups in 2024, the 90th-percentile provider charged a median 3.6× what the 10th-percentile provider charged for the identical service. For a hip replacement, billed by 8,164 surgeons, the spread reaches 16×.
2026-06-14 · 10 min - The 5% of prescribers behind half of Medicare's drug bill
In 2024 the top 5% of Medicare Part D prescribers — 56,973 of 1.14 million — accounted for 53.5% of the program's $226.7 billion drug bill, while the bottom half split 0.4%. The top 1% alone drove $53.5 billion. The Gini coefficient across prescribers is 0.841.
2026-06-14 · 11 min - The 1% of doctors who get two-thirds of industry money
In 2024 the top 1% of physicians — 9,792 of the 979,136 who received any industry money — captured 66% of every general-payment dollar tied to a recipient, $1.74 billion of $2.64 billion. The bottom half split 1.2%. Measured across recipients, the Gini coefficient is 0.927, far above the ~0.41 of US household income.
2026-06-14 · 11 min - GLP-1 makers paid 120,237 Medicare prescribers $32.8 million in 2024 — and the prescribers they paid wrote far more
In 2024, the makers of Ozempic and Mounjaro paid $32.8 million to 120,237 Medicare prescribers for meals, talks, and travel tied to GLP-1 drugs. Prescribers who accepted a payment wrote 78% more GLP-1 prescriptions than those who did not — a correlation this study reports at the group level, without inferring cause.
2026-06-12 · 12 min - The Most Expensive Prescription Drugs in Medicare Part D
Eliquis cost Medicare Part D $19.88 billion in 2024 — the single costliest drug in the program, yet only its 12th most-prescribed. That inversion defines Part D: brand-name drugs are 23.9% of prescriptions but 90.1% of the dollars, while cheap generics carry the volume and almost none of the cost.
2026-06-12 · 12 min - Industry payments to physicians by state: where the money lands
Industry's $3.31 billion in 2024 general payments to physicians spread across 59 U.S. jurisdictions, but not in proportion to population. California led at $334.5 million, yet Pennsylvania ranked third and Massachusetts fourth on far fewer payments — Massachusetts averaged $1,031 per payment against Texas's $153. Where royalty recipients live, not where patients are, shapes the map.
2026-06-12 · 10 min - Which companies pay U.S. doctors the most? Device makers, not pharma
In 2024, drug and device companies disclosed $3.31 billion in general payments to U.S. physicians under the Sunshine Act — and the largest payers are device makers, not pharma. BioNTech led at $180.6 million from just 164 royalty payments; the top 25 of 1,763 reporting companies account for 52% of every general-payment dollar.
2026-06-12 · 11 min - Which medical specialties take the most industry money?
In 2024, U.S. orthopedic surgeons received $381.4 million in general industry payments — more than any other specialty and over three times the second-place field. Counting spine, joint and sports-medicine subspecialties, orthopedics drew $531.8 million, about 16% of the $3.31 billion total. The average orthopedic payment was $1,711; the average internal-medicine payment was $96.
2026-06-12 · 11 min - What pharma actually buys: food, travel, consulting and royalties
Industry made 15.4 million general payments to U.S. physicians in 2024, worth $3.31 billion — but the two halves barely overlap. Royalties, speaking and consulting are 2.9% of payments yet 63% of the dollars; food and beverage is 91.7% of payments but 12.4% of the money. The average meal was $29; the average royalty, $56,258.
2026-06-12 · 10 min - The Open Payments Database, 2024: $11.96B in Industry Payments
The Open Payments database — the federal Sunshine Act disclosure file — recorded $11.96B in industry payments to US clinicians and teaching hospitals in 2024, across 16.1M records. The money is extraordinarily concentrated: royalties are 0.1% of records but 25.6% of the dollars, and orthopaedic surgery leads every specialty.
2026-06-12 · 12 min - The Most Prescribed Drugs in Medicare Part D (2024)
$226.7 billion bought 1.48 billion prescriptions in Medicare Part D in 2024. The most-prescribed drugs are almost all cheap generics, yet 90% of the dollars went to brand-name drugs — the anticoagulant Eliquis alone cost $19.9 billion, and GLP-1 drugs added $24.6 billion more.
2026-06-12 · 13 min - What Hospitals Charge for the Same Procedure (2024)
Across 4.95M Medicare inpatient stays at 2,906 hospitals in 2024, hospitals billed an average of $92,408 in covered charges but were paid about $18,360 — a roughly 5x gap. For the same procedure, list-price charges vary up to 59x between hospitals. Charge variation by DRG and state, with reproducible CMS methodology.
2026-06-12 · 12 min - Hospital charity care, by the numbers: who actually gives the most free care
Nonprofit hospitals — tax-exempt in exchange for community benefit — deliver charity care worth just 1.53% of their patient revenue, the lowest share of any ownership type, below for-profit hospitals (3.00%) and less than half the government rate (3.76%), across $27.68 billion in free care in the federal HCRIS cost reports.
2026-06-11 · 12 min - Rural hospital closures, by the numbers: which hospitals are most at risk
Rural Critical Access Hospitals — the small facilities at the center of the closure crisis — run a 50.4% financial-distress rate, against 39.2% for urban hospitals, across 6,019 Medicare hospitals in the federal HCRIS cost reports. Their average operating margin is −8.93%, and 682 are losing money on patient care.
2026-06-11 · 13 min - For Profit vs Nonprofit Hospitals: Who Owns Them, Who Profits
Across 6,019 US hospitals in the federal HCRIS cost reports, for-profit facilities are the only ownership class earning a positive average operating margin — +0.19% — while nonprofit hospitals average −4.75% and government hospitals −62.38%. The ranking holds on every measure, but the gap is narrower than the averages suggest.
2026-06-11 · 12 min - The OIG exclusion list, explained: who gets barred from Medicare, and why
The OIG List of Excluded Individuals and Entities (LEIE) holds 68,055 active exclusions spanning 1977–2026. The most common reason to be barred from Medicare is not fraud — it is losing a state license: §1128(b)(4) license actions are 41% of the list. And only 10.3% of records carry an NPI, so the list is mostly non-clinicians.
2026-06-11 · 11 min - Hospitals at Risk of Closing? The Days-Cash-on-Hand Signal
Federal HCRIS cost reports let us compute days cash on hand for 5,459 hospitals, but facility-level figures are distorted by system-level cash pooling — so the raw '2,800 hospitals under 30 days' headline is mostly noise. The defensible signal is narrower: 690 hospitals that report thin cash and also run an operating loss.
2026-06-04 · 14 min - Nursing Homes Banned From New Medicare Admissions: The DPNA List
1,950 US nursing homes have been barred from accepting new Medicare admissions under the Denial of Payment for New Admissions (DPNA) penalty (42 CFR §488.417), across 2,553 separate enforcement actions. A state-by-state breakdown, the longest active bans named from CMS data, and the reproducible SQL behind every figure.
2026-06-04 · 9 min - Hospital Profit Margins: The Gap Between Systems
Hospital profit margins vary enormously between systems: operating-margin data for 6,000+ U.S. hospitals, computed from CMS HCRIS cost reports (form 2552-10) and benchmarked against the national average. Per-hospital financial-distress flags, a state leaderboard, and the margin gap — published free with a named federal source, methodology, and limitations.
2026-05-24 · 8 min
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