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NY Medicaid Supported Adult Day Care Suspended Following Fraud Concerns

Last week we shared information about the revelations in the New York Times that efforts to curb New York Medicaid costs have been less than successful–mostly because of expanded enrollment in certain programs, like senior day care centers. These assistance centers are locations where frail and sometimes vulnerable elderly community members can stay during the day, while other caregivers–usually adult children–are at work. The facilities offer a way for seniors to avoid being forced to move into a long-term care home.

While useful, concerns have mounted regarding the tactics used by the operators of these facilities to increase enrollment. Owners of the adult care facilities are paid based on the number of eligible New York Medicaid recipients who attend. Therefore, it is in the best interest of the operators financially to increase enrollment–and that is exactly what they have been doing. The increase has been so stark, that some worry that the cost-savings intended (by averting expensive nursing home stays) may be illusory.

Temporary Suspension
In fact, some suggest that outright fraud is being committed in an attempt to attract seniors into the programs. According to a New York Times story, those fears prompted a sudden suspension of the program last week by state officials. The Times notes that the adult day care project is “New York’s largest managed long-term care plan for frail elderly and disabled people.”

The root of the concern was the tactics used by some centers to entice seniors to enroll. Accusations include giving away free fast food, visits to casinos, and even cash payouts. These seniors were convinced to join adult day care centers and then referred to other managed care companies for other services, like at-home nursing aides. State officials have suggested that this referral network abused the system, increased costs, and led to unnecessary services.

The officials are planning on auditing the most recent referrals from many of the largest providers to ensure only qualifying seniors are participating. According to the story, “People are eligible to enroll if they need at least 120 days of help a year with tasks like walking, cooking or taking medication.” Abuse of those guidelines would lead to excessive Medicaid payments. State officials plan on pursuing reimbursements for all money spent unnecessarily.

While it is important to root out fraud in the system all elder care attorneys understand that there are many seniors in New York with very real ailments that rely on Medicaid. Hopefully, this particular situation gets worked out soon so that no eligible residents is delayed support they critically need.

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