CMS Uses New Removal Power Against New York Adult Day Cares

According to STAT, the Centers for Medicare and Medicaid Services (CMS) held a press conference on Wednesday, Oct. 21, to announce the action. It targets centers that CMS says are committing fraud in New York's Social Adult Day Care program, known as SADC.

The program is meant to provide socialization, personal care and meals to adults with physical and cognitive impairments. CMS officials say it is rife with fraud. CMS Administrator Mehmet Oz called it "a plague to the state."

Oz also said fraud, waste and abuse are "demolishing programs that could have been helpful to seniors, especially those who are frail and suffering at home," according to STAT.

The announcement followed a field action the day before. STAT reported that federal agents searched several adult day care centers across the New York metropolitan area on Tuesday, Oct. 20. One of them was in Brooklyn.

For operators, the regulatory shift is the main point. The authority to remove providers from federal programs lets CMS act directly against a business's ability to bill. Medicaid is the main payer for this kind of care. Losing access to it can end a center's revenue. That is our reading of how such a tool works, not a detail from STAT's visible text.

The speed matters for planning. CMS moved within a week of receiving the power. Operators in other Medicaid-funded care settings may take that as a sign that new enforcement tools will be used quickly. That is an interpretation, and the source does not say CMS plans to widen its focus.

Much remains unknown. The visible portion of STAT's report does not say how many centers are targeted or how much money is at issue. It also does not describe the process for removal or any appeals. The full article is behind a paywall, so those details are not confirmed here.

The effect on patients is also unclear. The program serves frail adults who rely on daytime care. How removals would affect those enrolled, and where they would go, is not addressed in the available text.

What to watch next

Whether CMS names specific centers or releases figures on the scale of the alleged fraud, and whether it uses the same removal power outside New York.

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