Key Takeaways
- Adult day care Medicaid fraud probe: New York and federal investigators are examining more than 100 social adult day care providers.
- Medicaid payments under review: an audit the FBI cited found Medicaid paid roughly $2.4 billion for the service from January 2019 through October 2024.
- Prepayment review ordered: Gov. Kathy Hochul directed the state Department of Health and the Medicaid Inspector General to require health plans to check claims before payment.
- No charges reported: none of the sources reviewed ties an arrest or charge to the operation announced on Tuesday, October 20.
The news: New York and federal investigators are examining more than 100 adult day care providers suspected of possible fraud or other illegal activity, in an investigation that Gov. Kathy Hochul announced on Tuesday, October 20, 2026. Fingerlakes1 and Fox 5 New York both put the number under investigation at more than 100. An audit the FBI cited found Medicaid paid roughly $2.4 billion for the service from January 2019 through October 2024. By WYDE's arithmetic, the $2.4 billion covers 70 months, or about $34.3 million a month. The governor's release puts the benefit's estimated annual total cost at more than $500 million for approximately 45,000 Medicaid members. By WYDE's arithmetic, that works out to about $11,100 per member a year.
Federal agents at Queens and Brooklyn adult day care sites
NY1 reported that federal agents carried boxes out of a social adult day care provider in Flushing, Queens, on Tuesday, and saw agents at two Brooklyn locations. Fox 5 New York reported activity at adult care centers across New York City, including in Brooklyn, Queens, Staten Island and Manhattan. Fingerlakes1 reported that months of groundwork by state health officials, a Medicaid watchdog office and the FBI came before the probe.
NY1 also reported that Hochul said the state is targeting providers it believes engaged in illegal activity, ranging from money laundering to kickbacks to improper billing. None of the sources reviewed reports an arrest or charge tied to the October operation.
Prepayment review and the future of the adult day care benefit
The governor's release says Hochul directed the Department of Health and the Office of the Medicaid Inspector General to require health plans to put prepayment review in place for social adult day care claims, and the release also calls for payment suspensions. The release quotes her saying, "New York has zero tolerance for fraud, and when bad actors take advantage of these critical programs, older New Yorkers in need lose out."
Recommendations on the program's future are due to the governor by December 31. New York's 35 managed long-term care plans administer the benefit and oversee the centers, Fingerlakes1 reported. The Department of Health's moratorium on new providers, announced in July 2026, remains in effect until January 2027 and may be extended as needed.
Oversight record: 418 programs reviewed in 2025 and about 100 cases referred for prosecution from 2021 to 2025
The Department of Health reviewed 418 social adult day care programs for compliance in 2025. From 2021 through 2025, the Office of the Medicaid Inspector General investigated 387 subjects and referred approximately 100 cases for potential criminal prosecution, according to the governor's release.
The governor's release says two people in Brooklyn pleaded guilty earlier this year to a $68 million adult day care fraud scheme, and that state and federal investigators announced separate charges over an alleged $120 million Medicare and Medicaid scheme in Queens. In February, the state comptroller's audit found $285 million in questionable Medicaid payments for service dates after providers were terminated from at least one of six managed long-term care networks. Related WYDE coverage: Four Men Used ChatGPT to Fake Records in a $2.2 Million Minnesota Medicaid Fraud and Orange County Pharmacy Operator Pleads Guilty to $270 Million Medi-Cal Fraud Built on Prior Authorization Loophole.
What the $2.4 billion figure measures and what it does not
The $2.4 billion is total Medicaid payments, not an amount found to have been stolen. NY1 reported that investigators are still looking into whether some of that money was stolen.
The two figures come from different sources and periods, so they are not directly comparable.
People Also Ask
Has anyone been charged in the New York adult day care Medicaid investigation?
No arrest or charge tied to the operation announced on Tuesday, October 20 appears in the governor's release or in the news reports reviewed. The Brooklyn guilty pleas and the Queens charges are separate, earlier matters.
How much Medicaid money went to social adult day care?
An audit the FBI cited found Medicaid paid roughly $2.4 billion for social adult day care from January 2019 through October 2024, according to NY1. The $2.4 billion is a payment total, not a loss estimate.
What is social adult day care?
Social adult day care is a nonmedical benefit in New York's Medicaid Managed Long Term Care program. Centers provide daytime supervision, meals, social activities and personal care, and more than 400 programs serve approximately 45,000 Medicaid members, according to the governor's release.
Sources: Governor's office, NY1, Fingerlakes1, Office of the State Comptroller, Fox 5 New York.