A state audit has uncovered $285 million in questionable Medicaid payments to Social Adult Day Care programs, along with safety concerns and compliance failures, according to State Comptroller Thomas P. DiNapoli.
The findings come as federal authorities recently charged two Queens men with allegedly defrauding Medicare and Medicaid of $120 million through illegal kickbacks, bribes, and billing for services never provided. DiNapoli’s office referred its audit findings and worked with law enforcement on the investigation.
“Many vulnerable New Yorkers rely on social adult day care services to help them stay in their own homes and communities. But without stronger oversight from the Department of Health, we risk both the well-being of these individuals and the misuse of taxpayer dollars,” DiNapoli said.
Social Adult Day Care programs provide personal care and other services in structured settings for adults with chronic illnesses or disabilities. The Department of Health oversees the programs.
Questionable payments and documentation gaps
Auditors found $285 million in Medicaid payments to programs for service dates after they were terminated from at least one Managed Long-Term Care network. That total includes $28.5 million paid to a provider terminated for cause, which can include fraud, waste, or abuse.
At three programs — two locations in Gravesend and Coney Island, Brooklyn; one in Flushing, Queens; and another in Freeport — auditors identified $672,147 in claims that lacked proper documentation, including missing or unsupported sign-in sheets used to verify attendance.
The audit also flagged occupancy and safety concerns. A Gravesend facility that opened in 2018 received a violation in June 2022 for failing to amend its certificate of occupancy. At a Flushing program with a legal capacity of 323 people, auditors found 386 dates when claimed attendance exceeded that limit. On one day, the program billed for 530 people — 207 over capacity — and received $47,255 for that single day.
Assessment and service plan failures
Providers must complete individual assessments before admitting participants and develop service plans within 30 days, updating them annually or when needs change.
Auditors reviewed 15 member files and found incomplete or noncompliant assessments or service plans in 14 cases. They also found the Department of Health did not review initial assessments or prior service plans during site visits.
Comptroller calls for stronger oversight
DiNapoli recommended that the Department of Health review the $285 million in payments made after program terminations and determine corrective action, including potential recoveries. He urged prioritizing the $28.5 million paid to providers terminated for cause.
The audit also calls for stronger monitoring, uniform documentation standards, better use of claims data to detect occupancy violations, and ensuring proper certificates of occupancy before programs enroll participants. DiNapoli recommended notifying all Managed Long-Term Care plans when a provider is terminated for cause.
State Health Commissioner Dr. James McDonald said New York maintains strong oversight systems and remains committed to preventing waste, fraud, and abuse while supporting essential health programs.
The Department of Health outlined steps it is taking to address the findings in its official response to the audit.
FingerLakes1.com is the region’s leading all-digital news publication. The company was founded in 1998 and has been keeping residents informed for more than two decades. Have a lead? Send it to [email protected].