The CDC publishes overdose mortality through the National Vital Statistics System, CDC WONDER, and monthly VSRR provisional counts — tracking 107,000+ annual drug deaths at the county, demographic, and drug-category level. Here is the ICD-10 code structure, the three waves of the opioid epidemic, racial disparity inversion driven by fentanyl, and how to access the data.
Writing · topic · 83 articles
Health and medicine
Hospitals and Medicare, drugs and devices, and public-health surveillance from CMS, FDA, and CDC.
The FDA publishes every warning letter on its website — pharmaceutical cGMP violations, food safety failures, device adulteration, and clinical investigator fraud. Here is the enforcement hierarchy from Form 483 to criminal referral, how to access and scrape the letter database, and what the record reveals about repeat violators and food safety trends.
The US organ-procurement, transplant, and tissue system, assembled from government records: hundreds of source-linked findings on a federally protected monopoly, the procurement-vs-care conflict at the bedside, the consent gaps over unclaimed bodies, the money, the prosecutions, and the sworn testimony. The index to the whole OrganWatch investigation. Institution level, zero personal data.
Organ and tissue industry · Health and medicine · Transparency and open data
For the first time, the US government grades every organ procurement organization on objective outcome measures and publishes the result. The tiers are damning: roughly a third of OPOs sit in the lowest band, which CMS itself deems out of compliance and eligible for decertification. A sourced reading of the CMS tier data — what the tiers mean, which OPOs are in Tier 3, and how the first-ever decertification finally happened.
Health and medicine · Organ and tissue industry · Transparency and open data
The consent gaps in US body donation exist because there is a paying market on the other side. A sourced account of the demand side: medical-device companies that run cadaver labs, the US military buying donated bodies for blast and landmine testing, surgical-training firms, and the per-part price market that moved tens of thousands of bodies — all lawful, because federal law bars selling organs for transplant but barely touches the non-transplant body trade.
Health and medicine · Organ and tissue industry · Transparency and open data
The consent gaps in US body and tissue donation are not theoretical — they have a criminal record. A sourced account of the court cases: a $58.5M verdict against an Arizona body-donation company, federal prison for operators who sold bodies with forged consent, convictions for shipping disease-infected tissue, and the 2025 Harvard Medical School morgue trafficking case — set against the law that bans selling transplant organs but barely touches the non-transplant body trade.
Health and medicine · Organ and tissue industry · Transparency and open data
If you died unclaimed, could your body be sent for dissection or research without consent? The answer depends almost entirely on the state. Reading the statutes for all 51 US jurisdictions finds that 33 permit use of an unclaimed or indigent body without affirmative next-of-kin consent, and only 13 require consent. A sourced, de-identified map of the 50-state patchwork.
Health and medicine · Organ and tissue industry · Transparency and open data
The hardest question in the US organ system is at the bedside of the dying: when does recovery begin, and who is watching for the patient rather than the organ? In 2025 a federal HRSA review of 351 donation-after-circulatory-death cases found concerning features in roughly 29% and concluded a number of patients may not have been deceased when procurement began. A sourced, de-identified account of the dead-donor rule, the NRP controversy, the premature-procurement findings, and the structural conflict behind them.
Health and medicine · Organ and tissue industry · Transparency and open data
Organ donation is free; the system around it is not. The federally designated OPOs are cost-reimbursed regional monopolies, and the largest are nonprofits reporting $100M+ revenue with seven-figure executive pay. A sourced follow-the-money account — the cost-plus model, the OPTN contract, the Senate Finance finding that OPOs have stronger incentives for tissue than for lifesaving organs, the for-profit tissue pipeline, lobbying against reform, and the federal audits. Institution/role level, zero personal data.
Health and medicine · Organ and tissue industry · Transparency and open data
When a person dies unclaimed or indigent in America, the law in most states lets their body be sent for dissection, research, or the for-profit body trade with no next-of-kin consent required. A sourced account of the consent gap — the state unclaimed-body statutes, the documented University of North Texas case, the coroner cornea-removal laws and the court split over whether a body is property, and the FDA exemption that leaves whole bodies and tissue barely regulated while transplant organs are tightly governed.
Health and medicine · Organ and tissue industry · Transparency and open data
The US organ-procurement system is a federally regulated monopoly — 56+ Organ Procurement Organizations with exclusive territories feeding a national network that had one contractor for nearly four decades. Its failures are documented by the government itself: a CMS performance rule, a bipartisan Senate Finance investigation, HRSA’s breakup of the monopoly, GAO and HHS-OIG audits, and in 2025 the first move to decertify an OPO. Sourced, with the public data behind it.
Health and medicine · Organ and tissue industry · Transparency and open data
There is no single US recall database — cars are recalled by NHTSA, consumer products by the CPSC, food/drugs/devices by the FDA, and meat and poultry by USDA-FSIS. A guide to weaving the four feeds into one cross-agency recall view, joined on firm name and date, with the hazard-classification mismatches and what a unified view reveals.
Consumer protection · Health and medicine · Transportation safety · Engineering and infrastructure
Six federal datasets follow a prescription drug across its life — FDA approval, the National Drug Code directory, CMS Open Payments (manufacturer payments to prescribers), Medicare Part D prescribing and spending, and CDC overdose mortality — joined on the NDC code, ingredient, and manufacturer. The keys, the brand/generic and NDC-format gotchas, and what the assembled pipeline answers.
Health and medicine · Transparency and open data · Engineering and infrastructure
The US food-safety system is split across three federal agencies — CDC epidemiology, USDA FSIS recalls of meat and poultry, and FDA recalls of everything else — and the chain from a detected outbreak to the recall that pulls contaminated food off shelves only comes together when their datasets are joined. This guide traces that chain through public, key-free data, aligning the records by pathogen, product, firm, and time.
Food and agriculture · Health and medicine · Engineering and infrastructure
No single federal dataset shows the opioid epidemic whole — but three of them, joined on geography, do. This guide aligns the DEA’s ARCOS record of how the pills were shipped, the CDC’s death-certificate record of how people died, and the CMS record of where Medicare addiction treatment reaches survivors, so the supply, the toll, and the response line up in one geographic view.
No single federal file tells you how Americans die — five CDC mortality datasets do, when you assemble them: the leading-causes ranking, the injury and external-cause records, the suicide series, drug-overdose mortality, and excess deaths. All are cut from the same National Vital Statistics System death certificates, so they share join keys and age-adjustment, and the work is aligning their cause definitions rather than parsing five separate NCHS releases.
Consolidation is the defining force in American healthcare, but it leaves its fingerprints across four separate CMS records that do not share a key. This is a field guide to bridging the provider-ownership files, the change-of-ownership transactions, and the Care Compare quality datasets through the enrollment-to-CCN crosswalk — turning who owns a facility, the deal that changed it, and the staffing and outcomes that followed into one traceable, facility-level story.
Health and medicine · Ownership and consolidation · Engineering and infrastructure
Home infusion therapy — antibiotics, immune globulin, chemotherapy, and parenteral nutrition delivered into a vein or under the skin at a patient’s kitchen table — became a permanent Medicare benefit only on January 1, 2021. CMS keeps the enrollment record of the suppliers qualified to bill for it: roughly 324 home infusion therapy suppliers, a small and concentrated census of a benefit just a few years old.
Every year the CDC ranks the top causes of death in each state — heart disease, cancer, unintentional injury, and the rest of the top ten — with counts and age-adjusted rates standardized so a young state and an old one can be compared on a like-for-like basis. This is the top-level view that sits above the cause-specific mortality datasets.
CMS publishes the full ownership filings for every Medicare-enrolled hospital — naming the health systems, private-equity firms, and real-estate investment trusts with a direct or indirect interest in each facility, keyed to the hospital’s PECOS enrollment and associate IDs (not the CMS Certification Number, which the file does not carry). A field guide to the ~147,000-record hospital all-owners file: the disclosure rule behind it, the schema and role codes, how to trace an opco/propco/REIT chain, the Steward–Medical Properties Trust collapse, the joins to change-of-ownership data and, through an enrollment-to-CCN crosswalk, to quality data, a worked Python walkthrough, and the caveats of self-reported ownership.
Health and medicine · Ownership and consolidation · Federal data
When a vaping device’s battery overheats in a pocket, when a pouch of tobacco arrives webbed with mold, when an e-liquid triggers a reaction no label warned of, the complaint can land in one federal file — the FDA’s Tobacco Product Problem Reports. This deep-dive walks the ~1,300-report dataset behind tobacco and vaping safety surveillance: the 2009 statute that created the Center for Tobacco Products, the 2016 deeming rule that pulled e-cigarettes in, the product and problem taxonomy, the underreporting and causation caveats, and a Python workflow over the openFDA tobacco endpoint.
When a dog seizes after a flea-and-tick chew or a horse colics after a dewormer, the report often lands in the FDA Center for Veterinary Medicine’s adverse-event system — the veterinary counterpart to FAERS. This guide covers the ~25,000-report dataset, the passive-surveillance model, the species-and-reaction taxonomy, and a Python walkthrough of the openFDA animalandveterinary/event API.
When a hospital or nursing home is sold, the new owner usually inherits the seller’s Medicare provider number, compliance history, and liabilities — and that transfer leaves a CHOW record. The roughly 5,900-row CMS change-of-ownership dataset is the transaction-level ledger of healthcare consolidation: who bought which facility, from whom, and when.
Health and medicine · Ownership and consolidation · Federal data
Every facility on earth that makes, repackages, relabels, or imports a medical device for the US market must register with the FDA each year and list the devices it handles — roughly 324,000 establishments keyed by FEI and registration number. This is the federal worldwide map of who handles what in the device supply chain, and the registry that ties manufacturers, contract makers, specification developers, repackagers, and importers to the device product codes they touch.
Suicide is one of the leading causes of death in the United States, and one of the few that rose for most of two decades. The CDC/NCHS suicide-mortality record — age-adjusted and crude rates by year, sex, age group, and method, built from death-certificate data in the National Vital Statistics System — is the baseline that prevention policy aims to lower. A field-level guide to the data behind 988 and the suicide-prevention effort.
Premarket Approval is the FDA’s most stringent device pathway — the route a Class III device must take to reach the US market, proving its own safety and effectiveness with clinical evidence rather than borrowing equivalence from a predecessor. This guide walks the ~56,000 PMA approvals and supplements: originals versus supplements, the PMA-vs-510(k) divide, advisory-committee specialties, the supplement lifecycle, and a Python workflow against the openFDA device/pma endpoint.
For the first fifty-five years of Medicare, the program would not pay a methadone clinic a cent — until the SUPPORT Act built a Part B bundled benefit that took effect in January 2020. This guide walks the CMS enrollment file of the roughly 1,300 opioid treatment programs now billing Medicare: the 42 CFR Part 8 rules, the SAMHSA-DEA-accreditation triad, the schema keyed by CCN and enrollment ID, and a Python workflow that maps treatment capacity against the overdose burden.
Federally Qualified Health Centers and Rural Health Clinics are the two Medicare clinic types that anchor the primary-care safety net in low-income and rural America — and CMS’s enrollment files are the supply map of where they sit, who runs them, and under what status. A field guide to ~16,600 clinic enrollments, the statutes behind them, and how to join them to ownership and provider data.
The VA Office of Inspector General is the independent watchdog over the second-largest federal department — the nation’s largest integrated health system, the benefits administration, and the cemeteries. Roughly 4,280 reports, keyed to the facility or program reviewed, span healthcare inspections, benefits audits, construction reviews, and criminal investigations — the documentary trail behind the Phoenix wait-time scandal and the accountability that followed.
When CMS revokes a provider’s Medicare billing privileges, it ends their ability to bill the program and attaches a re-enrollment bar of one to ten years — up to twenty for the worst cases. A field-level guide to 42 CFR 424.535, the revocation reasons, the re-enrollment bar, how revocation differs from an HHS-OIG exclusion, the ACA screening expansion, and a Python workflow over the genuine data.cms.gov revocations file.
No national survey can measure diabetes or smoking at the scale of a single neighborhood — the samples are far too small. CDC PLACES solves that with model-based small-area estimates, projecting survey responses onto every US census tract; the tract-level file runs to ~3.05 million tract-by-measure rows, the data behind neighborhood health-equity work.
Excess deaths are the gap between how many Americans actually died and how many a statistical model expected — the measure that captured the full toll of COVID-19, including the undiagnosed and the indirect deaths the official tally missed. A field-level guide to the NCHS excess-mortality dataset: the over-dispersed Poisson baseline, the observed-versus-expected threshold, jurisdiction-by-week structure, provisional lag, and a worked data.cdc.gov Python walkthrough.
The HHS Office of Inspector General is the largest inspector general in the federal government, and its enforcement record — roughly 10,900 settlements, civil monetary penalties, and corporate integrity agreements — is the closest thing there is to a map of where healthcare-fraud risk has concentrated, from drug makers and hospital systems to nursing homes and labs. A field-level guide to the False Claims Act, the Anti-Kickback Statute, the Stark Law, CIAs, the LEIE relationship, and a Python workflow over the genuine oig.hhs.gov enforcement listing.
HCAHPS is the first national, standardized survey of what patients actually experienced in the hospital — nurse communication, responsiveness, cleanliness, the 0-to-10 rating, the would-recommend question — adjusted for survey mode and patient mix so hospitals can be compared fairly. A field-level guide to the ~326,000 hospital-by-measure records published on Care Compare, how the scores feed Hospital Value-Based Purchasing and Medicare payment, and a Python workflow that ranks hospitals, computes state averages, and tests whether response rate tracks score.
For every Medicare-certified hospital, CMS publishes the ZIP codes its patients come from — a hospital-by-patient-ZIP crosswalk of beneficiaries, cases, and charges that is the federal data behind hospital-market definition, merger antitrust review, and the Dartmouth Atlas tradition. A field-level guide to the ~1.16 million-row Hospital Service Area file, why small cells are suppressed, and how to compute catchments and market concentration in Python.
The CDC’s National Center for Health Statistics compiles every injury death in the United States from the death certificates filed under the National Vital Statistics System — the federal record behind the overdose epidemic, firearm deaths, rising suicide, and motor-vehicle fatalities, classified by mechanism and intent and reported as age-adjusted rates per 100,000.
Every US hospital reports the bloodstream infections, urinary-tract infections, MRSA, and C. diff its patients acquire while in its care — and CMS publishes the standardized infection ratios on Care Compare. Roughly 173,000 hospital-by-measure records covering the SIR, the observed-versus-predicted math, the HAC penalty money, and a worked data.cms.gov walkthrough.
HHS-OCR publishes every reported healthcare data breach affecting 500+ patients — the "Wall of Shame." Over 5,000 entries covering ransomware attacks, stolen laptops, unauthorized employee access, and business associate failures. Here is what the database contains and what it reveals about healthcare security failures.
Federal data · Health and medicine · Cybersecurity and privacy
How we indexed 380 million DEA ARCOS controlled-substance transaction records from the opioid MDL discovery release, what the data reveals about pill distribution, and how to cross-reference it against DEA enforcement actions and CDC overdose mortality.
Every year the federal government calls roughly 400,000 Americans and asks how tall they are, how much they weigh, how often they exercise, and how many vegetables they eat. The CDC Nutrition, Physical Activity, and Obesity dataset is the state-by-state distillation of those answers — the most comprehensive federal record of how American health behavior varies across geography, income, race, and education.
After a hospital stay ends, the least visible part of American healthcare begins — the home health nurse, the hospice, the skilled nursing facility. Medicare spends roughly $60 billion a year on this post-acute care, and CMS publishes a provider-level record of how much each agency, hospice, and nursing facility delivered and was paid, across roughly 28,404 provider-by-measure rows.
For nearly every nursing home, home health agency, hospice, and hospital that bills Medicare, the federal government now publishes who owns it — the holding companies, management firms, real-estate trusts, and private equity funds stacked behind the name on the door. The CMS all-owners files under 42 CFR 455.104 are an X-ray of who controls American institutional care, with roughly 280,000 ownership records for nursing homes alone plus home health, hospice, and hospitals.
Health and medicine · Ownership and consolidation · Federal data
The FDA National Drug Code Directory is the federal index of every drug product marketed in the United States — roughly 40,000 active listings, each keyed by its three-segment NDC and carrying brand and generic names, labeler, dosage form, route, active ingredients, DEA schedule, and marketing dates. The NDC is the universal serial number of the American drug supply.
The FDA Product Classification database is the master taxonomy of American medical devices — roughly 7,058 device types, each pinned to a three-letter product code, a risk class (I, II, or III), a CFR regulation number, a medical specialty panel, and the premarket pathway a manufacturer must clear to sell it, forming the schema beneath every 510(k), PMA, registration, and adverse-event report.
The CMS Doctors and Clinicians national file is the closest thing the United States has to a public directory of who practices medicine inside Medicare — roughly 163,000 physician and clinician records carrying NPI, specialty, medical school, graduation year, group practice, hospital affiliation, and whether the provider accepts Medicare assignment.
The openFDA Food Enforcement dataset surfaces every food and cosmetic recall the FDA has classified through its Recall Enterprise System — roughly 25,000 records carrying the recall reason, recalling firm, hazard class (I, II, III), distribution footprint, and the dates that trace each recall from initiation to termination.
Health and medicine · Food and agriculture · Consumer protection · Federal data
How joining CMS Open Payments (100M+ pharma payments to physicians) with Medicare Part D prescribing data (25M+ provider-drug rows) surfaces the correlation between manufacturer payments and prescribing patterns — and how to cross-reference with HHS OIG exclusions.
The EPA Safe Drinking Water Information System tracks every violation of the Safe Drinking Water Act by the 150,000 public water systems in the United States — health-based violations for exceeding maximum contaminant levels, monitoring failures, reporting violations, and treatment technique violations — creating the most comprehensive federal record of drinking water safety failures.
The Substance Abuse and Mental Health Services Administration publishes the most comprehensive federal data on addiction treatment and mental health services in the United States — the National Survey on Drug Use and Health, the Treatment Episode Data Set covering 2 million annual admissions, and the National Mental Health Services Survey covering 12,000 treatment facilities.
The CDC Foodborne Disease Outbreak Surveillance System tracks every reported multi-person foodborne illness outbreak in the United States — pathogen, implicated food, setting, illness count, hospitalizations, and deaths — covering 800+ outbreaks per year across all food categories.
CMS publishes annual Medicare Part D prescriber-level drug spending data for every provider who prescribed drugs covered under Medicare — enabling researchers to identify outlier prescribers, track opioid prescribing patterns, and analyze drug spending by specialty and geography.
The Drug Enforcement Administration publishes every order to show cause, immediate suspension order, and final order revoking a DEA registration — the controlled substance prescribing licenses held by physicians, pharmacies, hospitals, and distributors.
The CMS Hospital Cost Report database contains detailed financial and utilization data for every Medicare-participating hospital — revenues, costs, charges, staffing, beds, and patient days — making it the most comprehensive source of US hospital financial data.
The National Notifiable Diseases Surveillance System aggregates case reports from all 50 states and territories for 120+ nationally notifiable diseases — from salmonellosis and Lyme disease to HIV, hepatitis, measles, and emerging threats.
The CMS Hospital Compare program publishes readmission rates, patient safety indicators, HCAHPS patient satisfaction scores, and payment data for every Medicare-certified hospital in the United States.
The FDA Adverse Event Reporting System contains every post-market drug safety report submitted since 1968 — manufacturer reports, voluntary consumer reports, and FDA-initiated reports — totaling over 26 million case submissions.
ClinicalTrials.gov (NLM, launched February 2000 per FDAMA 1997): 500,000+ registered studies as of 2024. FDAAA 801 (2007): mandatory registration within 21 days of first enrollment for applicable clinical trials (ACTs -- Phase 2+ interventional trials of FDA-regulated drugs/biologics/devices); results reporting within 12 months of primary completion date; penalties up to $10,000/day; NIH grant withholding; but 2015 NEJM study found only 13% reporting on time. Study phases: Phase 0 (microdosing), Phase 1 (safety, 20-80 participants), Phase 2 (efficacy signal, 100-300), Phase 3 (pivotal RCTs, FDA approval basis), Phase 4 (post-marketing); observational (cohort/case-control/cross-sectional) studies phased differently. Key fields: NCT number, official title, brief summary, sponsor type (industry ~50%, NIH/federal ~20%, academic ~30%), study status, phase, allocation, intervention model, masking, primary completion date, enrollment, primary outcome measures, eligibility criteria (inclusion/exclusion), age range, gender, MeSH condition terms, intervention type (drug/device/behavioral/procedure). Disease area composition: oncology ~35%, diabetes/cardiology/psychiatry/ID follow. COVID-19 surge: ~11,000 COVID trials 2020-2021. Publication bias (file drawer problem): AllTrials campaign, Ben Goldacre, COMPARE project, RIAT. ClinicalTrials.gov API v2 at clinicaltrials.gov/api/v2/studies: no API key, pagination by pageSize/pageToken, protocolSection/resultsSection/statusModule/conditionsModule modules. Aggregate stats: ~40% completed, ~25% recruiting, ~15% terminated. Python API query: recruiting Phase 3 oncology trials by enrollment (top 10) + phase distribution for all cancer trials.
DEA ARCOS (Automation of Reports and Consolidated Orders System): mandatory reporting under 21 USC 827 + 21 CFR 1304.33 for all manufacturers/distributors/importers of Schedule I/II controlled substances. 380M individual opioid transaction records 2006-2014 (oxycodone, hydrocodone, fentanyl, morphine, hydromorphone, methadone, oxymorphone, buprenorphine). Transaction fields: reporter DEA number, buyer DEA number, drug code, drug name, dosage unit, quantity, transaction date, transaction type (S=sale, P=purchase, T=theft/loss, R=return). MDL 2804 (In re: National Prescription Opiate Litigation, Judge Polster, NDOH): July 2019 court order released ARCOS data to Washington Post and HD Media -- first-ever public transaction-level release. Key findings: 76B oxycodone/hydrocodone pills shipped 2006-2014; WV ~780 pills/person/year; Mingo County WV: 3.3M hydrocodone pills over 2 years for 25,000 people; McKesson, Cardinal Health, AmerisourceBergen (Big Three) distributed 44% of all opioids. Suspicious order monitoring failure: 21 CFR 1301.74(b) requires reporting unusual orders; DEA settlements: McKesson $150M + registration surrenders 2017, AmerisourceBergen $150M 2017, Cardinal Health $44M. Purdue Pharma: OxyContin 1996, $634M 2007 plea, $8.34B 2020 settlement, Sacklers $6B; Mallinckrodt $1.6B. Big Three civil settlement $21B (2022); J&J $5B; Walgreens $5.7B; CVS $5B; Walmart $3.1B; total settlements $55B+. Washington Post bulk download at WaPo arcos-database pages; arcos R package. Python WaPo bulk TSV download: pills-per-capita by county for oxycodone/hydrocodone, top distributors, annual trend.
CMS Five-Star Quality Rating: ~15,000 Medicare/Medicaid-certified nursing homes, ~1.35M residents, ~$90k-105k/yr private pay. Three domains: Health Inspections (standard annual + complaint surveys; F-tag deficiency system F600-F999; scope/severity matrix A-L; immediate jeopardy J-L), Staffing (Payroll-Based Journal PBJ quarterly since 2017: RN hours/resident day, total nurse hours/resident day, weekend staffing), Quality Measures (MDS 3.0 derived: long-stay high-risk pressure ulcers, falls with major injury, antipsychotic use in dementia, UTI; short-stay pressure ulcer + improved function). Special Focus Facilities (SFF): ~90 facilities with persistent serious quality problems; ~400 on SFF Candidate list; monthly CMS publication; decertification risk. Ownership transparency: Form CMS-855A; private equity association with lower staffing (Braun 2021, Harrington 2020); large chains: ManorCare/ProMedica (~250 facilities), Genesis Healthcare. data.cms.gov datasets: Provider Information (CMS_Certified_Nursing_Facilities.csv), Health Deficiencies, Quality Measures, Staffing, Penalties (CMPs). Socrata API, no key required. Python Provider Info CSV analysis: star distribution, SFF flags, average staffing by star rating, top-10 states by 1-star share.
107,543 overdose deaths in 2023 (CDC NCHS provisional); first 100k+ year was 2021. Three-wave opioid crisis: Wave 1 prescription opioids (OxyContin 1996, Purdue 2007 $634M fine); Wave 2 heroin surge (2010-2013); Wave 3 synthetic opioids (IMF fentanyl 50-100x morphine, ~75k synthetic opioid deaths 2022). Three CDC sources: VSRR Provisional Drug Overdose Counts (monthly, Socrata API at data.cdc.gov, 12-month rolling), CDC WONDER (death certificate ICD-10 queries 1999-present, county-level), state drug category flat file. ICD-10 T-codes: T40.1 heroin, T40.2 natural/semisynthetic, T40.4 synthetic opioids (fentanyl -- the key field), T40.5 cocaine, T43.6 stimulants. Fentanyl supply: China scheduled 2019; Mexico (Sinaloa/CJNG) now primary; counterfeit M30 pills; xylazine (tranq) not reversed by naloxone. Geographic: WV ~80/100k; Appalachian epicenter. Purdue $8.34B 2022 DOJ settlement; Sackler $6B; total settlements >$55B. MOUD: buprenorphine (waiver removed 2022 SUPPORT Act), methadone, naltrexone. Python VSRR Socrata API synthetic opioid rate by state.
Medicare Part D (MMA 2003, implemented January 2006) covers outpatient prescription drugs for ~50M beneficiaries through private PDPs and MA-PD plans; ~$225B annual spending. CMS publishes Part D Prescriber Data (NPI, specialty, drug, total claims, total cost) and Drug Spending Dashboard. Top drugs by spending: Eliquis (apixaban) ~$14B, Humira ~$6B pre-biosimilar, Keytruda ~$5B, GLP-1 agonists (Ozempic/Victoza) rapidly rising. PBM rebate mechanics: Tier 1-5 formulary; manufacturer pays 70% brand discount in coverage gap. IRA 2022: Medicare drug price negotiation (first 10 drugs 2026); $2,000 OOP cap 2025; inflation rebates. Humira 2023: 7 biosimilars launched simultaneously. ProPublica Prescriber Checkup identifies high-volume opioid prescribers. LIS/Extra Help: ~13M beneficiaries, full subsidy. CMS data at data.cms.gov. Here is benefit phases, formulary mechanics, IRA negotiation program, prescriber-level data structure, opioid prescribing patterns, and a Python analysis of specialty drug spending.
The Physician Payments Sunshine Act (ACA Section 6002, 2010) requires applicable manufacturers to report all payments ≥$10 to covered recipients. 2022 dataset: $12.7B total; research payments ~$4B; general payments ~$2.5B; ownership/investment interests ~$6.2B. ~2,700 applicable manufacturers; ~900,000 covered recipients. Three datasets at openpaymentsdata.cms.gov: General Payments (GP), Research Payments (RP), Ownership/Investment Interests (OI). Key fields: NPI, total_amount_of_payment_usdollars, nature_of_payment (consulting/speaking/food/royalty/research), drug/device name, manufacturer. NPI linkage to NPPES enables physician specialty/location cross-reference. ProPublica "Dollars for Docs" since 2010. Research: Carey et al. (2021) meals associated with brand prescribing; DeJong et al. (2016) payment receipt and prescribing patterns. Dispute process: 45-day window before publication. Socrata API at data.cms.gov/open-payments. Here is Sunshine Act mechanics, payment category taxonomy, scale data, prescribing-impact research, drug-specific linkage (Ozempic/Humira/insulin), and a Python Socrata API analysis by specialty and manufacturer.
CDC WISQARS (Web-based Injury Statistics Query and Reporting System) covers all US injury deaths (ICD-10 external cause V-Y) back to 1981 and nonfatal ED visits via NEISS-AIP. 2022: unintentional injury ~230k deaths (#1 cause ages 1-44); drug overdose ~109,680 (fentanyl/synthetics ~73,800); motor vehicle ~46,000; suicide ~49,000 (firearms 55%, hanging 27%); homicide ~24,000 (firearms 79%). Total firearm deaths 48,204 (14.6/100k). Three opioid waves: prescription, heroin, fentanyl. WISQARS API, WONDER, NVDRS (case-level violent deaths with circumstance data). Geographic patterns: firearm suicide highest in rural Mountain West; firearm homicide concentrated in urban areas. Here is ICD-10 coding, NEISS methodology, and a Python state firearm rate analysis.
CMS publishes annual Medicare Inpatient Provider Charge Data for ~3,000 hospitals across ~760 DRGs. The IPPS pays a fixed amount per DRG via relative weights (RW) — DRG 001 Heart Transplant RW ~25.0, DRG 470 Major Joint Replacement RW ~2.1, 2023 base rate ~$6,000. Medicare pays ~$170B/year via IPPS. Adjustments include Wage Index, IME for teaching hospitals, DSH for safety-net hospitals, and outlier payments. Chargemasters produce 5x-10x sticker prices vs. actual payments. Geographic variation: DRG 470 ranges $12,000–$35,000+ across hospitals. Here is the full dataset schema, Socrata API access, value-based care adjustments (HVBP, HRRP, HACRP), and a Python charge-to-payment ratio analysis.
The FDA Orange Book lists approved drugs and their TE ratings (AB = substitutable bioequivalent). Hatch-Waxman Act (1984) created the ANDA pathway — generics skip clinical trials, show bioequivalence. Paragraph IV certification challenges listed patents → 30-month stay + 180-day first-filer exclusivity. Exclusivity types: NCE 5yr, new clinical investigation 3yr, Orphan Drug 7yr, Pediatric 6mo. Patent thickets: average 71+ listed patents per brand drug. Lipitor $10B/year cliff Nov 2011; Humira 2023 multi-biosimilar launch. Three flat files: Products.txt, Patent.txt, Exclusivity.txt. Here is TE code breakdown, pay-for-delay/FTC v. Actavis, Purple Book for biologics, and a Python upcoming patent cliff analysis.
CDC PLACES produces model-based small area health estimates for all 3,100+ counties, 29,000+ census tracts, and 28,000+ ZCTAs. 36+ measures across 5 domains: health outcomes (diabetes, obesity, CHD, stroke), prevention (screenings, insurance), unhealthy behaviors (smoking, binge drinking), disabilities, and social determinants. Uses multilevel regression and poststratification (MRP) applied to BRFSS survey data + Census ACS. Obesity >40% in Appalachian counties vs. <20% in Mountain West. Diabetes 15%+ in Mississippi Delta vs. <7% in Colorado. Socrata API at data.cdc.gov, GeoJSON endpoint, sodapy library. Here is full methodology, PLACES vs. County Health Rankings, and a Python Mississippi county health burden analysis.
The VA disability compensation program pays monthly benefits to ~5.5 million veterans (up from 3.5M in 2010) based on a 0–100% rating using a whole-person combined formula. Here is the 2024 compensation rate table ($171/month at 10% to $3,737 at 100%), the PACT Act 2022 and its 23 new burn pit presumptive conditions (3.5M newly eligible veterans, $280B 10-year cost), the GI Bill (Post-9/11 Ch. 33: tuition cap, BAH allowance, $1K books stipend), the VA Home Loan Guaranty (no down payment, 4M+ loans in FY2022), the claims processing system (884K 2012 peak backlog, three Appeals Reform Act review lanes), VSOs and TDIU (~370K recipients), and the VA Open Data portal with state-level benefits utilization data.
CMS Care Compare publishes quality data for every Medicare- and Medicaid-certified skilled nursing facility in the US. Here is the five-star composite rating system (health inspection, staffing, and quality measure components), the 3×4 scope/severity deficiency grid (A through L, Immediate Jeopardy at J–L), the Payroll-Based Journal staffing system that replaced self-reported data in 2016, the Minimum Data Set resident assessment that drives both quality measures and PDPM reimbursement, COVID-19’s toll on nursing homes (170,000+ deaths, 38% of early US COVID deaths), private equity ownership transparency gaps, and a Python script to download CMS Care Compare CSV files and compute state-level star rating distributions.
The EPA Air Quality System aggregates hourly and daily pollutant readings from 4,000+ monitoring sites operated by state, local, tribal, and federal agencies. Here is the six criteria pollutant NAAQS framework (PM2.5, PM10, ozone, CO, SO2, NO2), the 2024 PM2.5 standard tightened to 9 μg/m³, the AQI 0–500 scale and daily worst-of-pollutants calculation, nonattainment designation and State Implementation Plan mechanics, the Harvard Six Cities study and BenMAP health burden model (100,000+ annual PM2.5-attributable deaths), environmental justice monitoring gaps, wildfire smoke exceptional events provisions, and a Python script using the EPA AQS API to download daily PM2.5 readings and identify exceedance days.
Medicaid is the largest health coverage program in the US by beneficiary count (~90M people, ~$900B/year), administered by states under federal rules with FMAP matching. Here is the key data sources (monthly enrollment by eligibility group, T-MSIS claims data, MBES expenditure system), the ACA expansion 37-state vs. 13-holdout divide, the COVID continuous enrollment surge from 70M to 95M and the 2023–2024 unwinding that disenrolled millions, FMAP mechanics (50–77% federal match), managed care's 70% enrollment share, dual eligibles ($35K/year cost vs. $8K non-dual), long-term care payment (Medicaid covers 42% of all LTC spending), and a Python Medicaid.gov Socrata API unwinding analysis by state.
CDC WONDER is the query interface for US death certificate data — every death in America since 1999 coded by ICD-10 underlying cause, linked to place, age, race, and demographic characteristics. Here is the death certificate pipeline, ICD-10 code taxonomy (C codes for cancers, I codes for circulatory, F codes for mental, V–Y codes for external causes), the <10 death suppression rule, age-adjusted rates using the 2000 Standard Population, the three-wave opioid crisis (prescription T40.2–T40.3 to heroin T40.1 to synthetic fentanyl T40.4, ~110K deaths in 2022), Case–Deaton “deaths of despair” research, and COVID-19 U07.1 excess mortality analysis.
Medicare Advantage now covers 51% of Medicare beneficiaries (~33M people) through private insurance plans. Here is the CMS benchmark-bid-rebate payment system, the 40-measure Star Ratings framework, how HCC risk adjustment creates a $10–30B upcoding incentive, the prior authorization controversy (OIG 2022: 13% of denials met coverage criteria), enrollment concentration (UHC 29%, Humana 19%, CVS/Aetna 12%), and a Python market-share analysis by state.
The CDC Behavioral Risk Factor Surveillance System interviews ~450,000 adults per year across all 50 states — the world's largest health survey. Here is the core module variables (obesity, smoking, diabetes, exercise, mental health), the raking weighting methodology, the PLACES MRP small-area estimation project, how 2011 cell-phone addition created a trend discontinuity, and a Python approach to computing weighted state-level obesity prevalence from the LLCP XPT file.
The FDA CDER Drugs@FDA dataset tracks every drug approval action since 1939 — NDAs for brand drugs, BLAs for biologics, ANDAs for generics. Here is the Orange Book TE codes and patent/exclusivity listings, NCE/3-year/pediatric/orphan/biologic exclusivity mechanics, Breakthrough and Accelerated Approval designations, the Aduhelm controversy, and how to query OpenFDA drugs API.
The CMS Medicare Part B Physician and Supplier Public Use File covers 1M+ providers, 12,000+ HCPCS procedure codes, and $400B+ in annual submitted charges. Here is the submitted vs. allowed vs. payment markup ratio, standardized payments removing geographic wage index, the Lucentis/Avastin ASP+6% controversy, the Salomon Melgen $21M ophthalmology fraud, and how to filter anti-VEGF injections to expose the billion-dollar pricing disparity.
CMS Care Compare publishes quality measures for every Medicare-certified hospital — 30-day mortality and readmission rates, HCAHPS patient experience scores, process compliance, and Medicare spending per beneficiary. Here is the full measure taxonomy, how risk adjustment works, the HAC Reduction Program penalties, Value-Based Purchasing incentives, and how to download and analyze the data.
CMS publishes provider-level Medicare Part D prescribing data showing every drug prescribed by every provider with 10+ claims — 1M+ providers, 5,700+ drugs, $100B+ in visible prescription spending per year. Here is the full schema, how Part D data exposed the opioid crisis (ProPublica Prescriber Checkup), the GLP-1 agonist cost surge, and how to join it with CMS Open Payments to detect prescribing-payment correlations.
The FDA CDRH publishes every medical device recall action — Class I (serious health risk), Class II, and Class III — covering 1,000–1,500 recalls per year since 1999. Here is the full field schema, the three recall classes, the DePuy ASR ($4B settlement) and Philips Respironics CPAP (5.5M+ units) landmark recalls, how MAUDE adverse event reports feed recall decisions, and how to query the OpenFDA device recall API.
FDAAA 801 requires registration of all applicable clinical trials before enrollment and results submission within 12 months of completion — but 50%+ of trials still fail to report results. Here is the full NCT schema, how to access the AACT PostgreSQL mirror from Duke/CTTI, how to detect publication bias using the results reporting gap, and how the GLP-1 agonist trial explosion looks in the data.
The FDA 510(k) pathway clears medical devices by showing substantial equivalence to a predicate device — no clinical trials required. Here is the three-class device system, the K-number database fields, the predicate daisy-chain problem that lets cleared devices drift from the original, the De Novo pathway for novel low-risk devices, the metal-on-metal hip and vaginal mesh controversies, and how to query the OpenFDA device API.
The HHS OIG List of Excluded Individuals/Entities (LEIE) bars providers from billing Medicare and Medicaid — with $10,000 per-service penalties for employers that fail to screen. Here is the exclusion type taxonomy, how to download the monthly LEIE CSV, how it differs from SAM.gov EPLS, and how to implement fuzzy-match screening against a provider roster.
The FDA Adverse Event Reporting System contains 7 linked quarterly files tracking drug adverse events reported by manufacturers, providers, and consumers — with MedDRA reaction coding, outcome classification, and therapy dates. Here is the schema, how disproportionality analysis (PRR/ROR) detects safety signals, and the Avandia/Vioxx/SSRI signal cases.
The False Claims Act is the government's primary anti-fraud tool, with qui tam whistleblowers driving 80%+ of the $2B+ in annual recoveries. Healthcare fraud dominates — Medicare and Medicaid upcoding, kickbacks, and unnecessary procedures. Here is how to access the DOJ settlement database, scrape press releases, and identify repeat violators.
Federal data · Justice and immigration · Health and medicine
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