CMS says audits of 15 New York City adult day centers found billing for people who weren't there. Here's how to check your parent's program

What happened

At a press briefing on October 21, officials from the Centers for Medicare & Medicaid Services (CMS) said a CMS team had audited 15 social adult day care centers in New York City. According to reporting from the briefing, CMS deputy administrator Kim Brandt said the team found Medicaid billing filed for people listed as participants who were not actually attending. CMS Medicaid director Dan Brillman said one center had billed for wheelchairs and disability aids even though no wheelchairs were on site. The same day, CMS sent New York the 90-day compliance warning letter we covered earlier.

The audits followed a coordinated state and federal operation on October 20. Gov. Kathy Hochul's office said investigators had targeted more than 100 social adult day providers suspected of fraud, and CMS staff made more than 80 visits across New York City. During one visit in Flushing, Queens, reporters saw sign-in sheets with names already entered for dates that had not happened yet.

A widely shared social media post on October 22 said all 15 audited centers had no records of meals, activities or supervision. We could not find that wording in CMS's own statements or in the reporting from the briefing, which describe billing for absent participants and unreliable attendance records. The findings concern the specific New York City programs that were audited and charged. They do not mean every adult day program is fraudulent, and no Western New York provider has been named.

Social adult day care is a Medicaid benefit offered through New York's managed long-term care plans. More than 400 programs serve about 45,000 people statewide at a cost of more than $500 million a year. The state has paused new providers until January 2027, ordered plans to review claims before paying them, and asked the Health Department to recommend by December 31 whether to reform the benefit or phase it out.

What it means for families

For most families the risk is not that a parent is being harmed. It is that a program's paperwork may not match what your parent actually receives, and that the benefit itself could change. A well-run program should be able to show you, without fuss, when your parent signed in, what they ate and what they did.

Expect slower approvals and more paperwork while plans tighten their reviews. If your parent attends a program, keep your own simple record of the days they go. If New York changes the benefit after December 31, that record and a good relationship with the plan's care manager will make a switch to another service easier.

What this means in New York: Report suspected Medicaid fraud to the Office of the Medicaid Inspector General at 1-877-873-7283 or omig.ny.gov. Questions about your parent's plan or services can go to the plan's care manager or to NY Connects at 1-800-342-9871.

What to do this week

• Ask the program to show your parent's sign-in record for the past month and compare it with the days they actually went.
• Ask for this week's menu and activity calendar, and ask your parent what they ate and did.
• Check your parent's plan statements for days billed that they did not attend.
• If something doesn't match, ask the plan's care manager first, then report it to OMIG at 1-877-873-7283.

Sources

• New York Has 90 Days To Fix Fraud Mismanagement, CMS Shares (Daily Caller News Foundation)
• Governor Hochul Announces Joint Effort to Crack Down on Fraud Within Social Adult Day Care Program (NYS Office of the Medicaid Inspector General)
• Dr. Oz confronts NYC senior care centers over suspected Medicaid fraud (Fox News)
• Related: CMS gives New York 90 days on Medicaid oversight (Senior Sentinel)

Senior Sentinel summarizes these reports in plain language. Read the originals for full detail. Spot an error? See our corrections policy.