CMS Gives New York 90 Days to Correct Medicaid Fraud Oversight in Adult Day Care Programs

The Centers for Medicare and Medicaid Services has given New York 30 days to respond and 90 days to come into compliance after issuing a warning letter over the state’s failure to adequately oversee Medicare and Medicaid programs, with particular focus on social adult day care centers.

CMS Director of Medicaid and Deputy Administrator Dan Brillman announced the letter. He said that if New York cannot produce a corrective action plan, the question becomes whether the problems can be fixed at all. CMS Administrator Dr. Mehmet Oz and other officials have described widespread questionable billing practices. Oz stated that the agency sent more than 100 notices of different kinds; some recipients face exclusion from billing federal programs, and related enforcement actions including arrests have occurred.

The social adult day care program is intended to provide socialization, personal care, and meals for adults with impairments. Officials have cited low attendance relative to high billing, questionable transportation charges, and other irregularities. Federal agents and partner agencies have conducted searches and delivered letters at centers in the New York metropolitan area.

The action is part of the administration’s broader effort against fraud, waste, and abuse in federal health programs. CMS has received expanded exclusion authority and has pursued payment suspensions and billing-privilege revocations in other contexts. New York must now submit plans demonstrating improved oversight of managed-care plans and providers.