An adult day care can deliver real services and still face questions about how its participants were recruited. A CDPAP business can process genuine care hours and still face scrutiny over payments to someone who brought in consumers. In a kickback investigation, the government examines the payment arrangement as well as the underlying care. For […]
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CDPAP Fraud Investigations in New York: What Caregivers and Providers Should Know
A CDPAP fraud investigation in New York may focus on whether Medicaid paid for care that actually occurred, whether the hours were authorized, or whether someone received money for arranging a patient’s participation. Caregivers, consumers, payroll staff, and business owners may have different responsibilities, even when investigators are reviewing the same claims. A payroll error […]
NYC Adult Day Care Raids: Medicaid Fraud Investigation and Legal Defense
Federal authorities conducted coordinated law enforcement operations at adult day care facilities across New York City on October 20, 2026, as part of ongoing investigations into suspected Medicaid fraud. The operations involved facilities in Brooklyn, Queens, and Staten Island and have raised serious concerns among adult day care operators and other Medicaid-funded healthcare providers. According […]
New York Medicaid Managed Care Audits: Why Providers Are Being Reviewed More Closely
A Medicaid managed care audit in New York may start with a health plan’s Special Investigation Unit, an outside audit vendor, or the New York State Office of the Medicaid Inspector General. The letter may ask for medical files, orders, service logs, billing support, employee information, or records tied to a defined group of claims. […]
OMIG Self-Disclosure in New York: When Should a Provider Consider It?
A billing error does not always arrive with an audit letter. It may surface during a routine claims review, an employee report, a software check, or a review of documentation that does not support what Medicaid paid. Once a New York provider identifies an improper Medicaid payment, the issue moves from an accounting concern to […]
What Happens When a New York Provider Gets an OMIG Education Letter?
An OMIG education letter can look less serious than an audit demand, but New York Medicaid providers should still take it seriously. The letter may not accuse the provider of fraud. It may not demand repayment right away. It may not ask for boxes of records by a strict deadline. Still, it can be an […]
