New York and federal investigators are examining more than 100 social adult day care providers suspected of possible fraud or other illegal activity in the state's Medicaid program. Gov. Kathy Hochul announced the coordinated investigation Tuesday and ordered a broader review of the benefit, including whether it should be reformed or phased out.
The inquiry follows months of work by the state Department of Health, the Office of the Medicaid Inspector General, the attorney general's Medicaid Fraud Control Unit, the FBI and other federal, state and local agencies.
Hochul directed state health officials to require managed long-term care plans to review social adult day care claims before payment and pursue payment suspensions where warranted.
What the program provides
Social adult day care is a nonmedical benefit for people enrolled in New York's Medicaid Managed Long Term Care program. Centers provide daytime supervision, meals, social activities and personal care in community settings. More than 400 programs serve about 45,000 Medicaid members statewide, at an estimated annual cost exceeding $500 million.
The benefit began in 2013 and is jointly funded and overseen by the state and federal governments. Social adult day care centers are not directly enrolled Medicaid providers. New York's 35 managed long-term care plans administer the benefit and are responsible for directly overseeing the centers and detecting, investigating and preventing improper payments.
Hochul asked the Health Department to examine stronger oversight and other ways to address persistent problems. The options include ending the benefit and moving participants to other services, but no decision to eliminate social adult day care has been announced. Recommendations are due to the governor by Dec. 31, with officials saying continuity of care for older adults is a priority.
Earlier oversight and enforcement
The Health Department reviewed 418 social adult day care programs for compliance in 2025. From 2021 through 2025, the Medicaid inspector general investigated 387 subjects connected to the program and referred about 100 matters to the attorney general's Medicaid Fraud Control Unit for possible prosecution.
Earlier this year, two people in Brooklyn pleaded guilty in a $68 million fraud scheme involving adult day care services. State and federal investigators separately announced charges in an alleged $120 million Medicare and Medicaid scheme tied to adult day care and pharmacy services in Queens.
New York imposed a moratorium on new social adult day care providers in July. It remains in effect through January 2027 and could be extended. The state has also tightened eligibility, certification, audit, staffing and recordkeeping requirements in earlier efforts to protect the program.
Attorney General Letitia James said her Medicaid Fraud Control Unit obtained 59 indictments and 13 convictions in fiscal 2026 and recovered more than $98 million through civil settlements. Across the broader Medicaid program, the state says integrity efforts produced more than $15 billion in savings and recoveries over five years; those amounts are not specific to this adult day care inquiry.
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