In August, the New York Post counted 77 adult day care centers within a one-mile radius in Queens. It found shuttered storefronts and rooms with no one in them. On Wednesday, Oct. 21, federal health officials said FBI agents and state officials had raided dozens of New York centers. The Journal's editorial page laid out the case Friday. We'll skip the politics and keep the facts, because the facts are a map for anyone with an aging parent.
Social adult day care is a Medicaid benefit. In theory, a center offers meals, personal care and company to adults who need help getting through the day. The bar to qualify is low. A person only has to say they need help with daily tasks, or need watching because of a memory, thinking or emotional problem. The Centers for Medicare and Medicaid Services, or CMS, says some centers worked that gap. They paid seniors kickbacks, cash for signing up, of up to $1,000 a month. Then they billed Medicaid for care nobody got. Some centers even filled out attendance sheets ahead of time. CMS administrator Mehmet Oz called the fraud a “plague to the state.”
The warnings go back years. News stories since 2013 have described centers drawing in healthy seniors with free food, cash and rides to the door, and casino trips too. In February, an audit by state Comptroller Thomas DiNapoli found centers billing for more people than their rooms could hold. At one center, the bills covered 530 people. That was 207 past its maximum capacity. The audit also found providers billing before they had checked what each person could and couldn't do.
What's happening now
On Staten Island, District Attorney Michael McMahon charged two providers this week. The charge is billing for people who had died or were out of the country. CMS has warned centers by letter that they could be thrown out of the program. Gov. Kathy Hochul says the state has “zero tolerance” for anyone who steals from taxpayers. She says she has told her administration to consider ending social adult day care as a Medicaid benefit. The Journal's editorial board has its own view on who deserves credit and blame. We'll leave that to the opinion page.
Our read
Insurance and Consumer Protection, M11. This is elder fraud, and the elder is the bait. Nobody legitimate pays a senior to enroll in care. Cash, free rides, free meals or outings in exchange for a Medicaid number are the kickback. The person signing in may think it's a perk. The bill goes to Medicaid under their name, and money meant for people who truly can't manage goes to a storefront instead. It's no free lunch. A Medicaid record full of care that never happened can follow the senior into any investigation that comes later.
Here's the check for your family. If a parent is on Medicaid, ask them this week whether anyone has offered cash, a ride or a free lunch to sign in somewhere. Then ask the state Medicaid office, or your parent's Medicaid health plan, for a record of the services billed under their number. Read it line by line. A day care your parent has never set foot in is the tell. Report it to the state's Medicaid fraud unit. You read the statement before the auditor does, and you lock the door before the stranger knocks. If you'd like help walking a parent through it, bring it to your next review.