CMS Warns New York: 30 Days to Answer, 90 Days to Comply; Audits of 15 Adult Day Care Centers Found Pre-Filled Billing
WASHINGTON — The Centers for Medicare & Medicaid Services (CMS) said at an October 21 press briefing that it has issued a compliance warning letter to the state of New York for failure to oversee its Medicare and Medicaid programs. Dan Brillman, CMS's Director of Medicaid and Deputy Administrator, said New York has 30 days to answer and 90 days to come into compliance with the agency's orders, and must produce a corrective action plan. Bloomberg Law reported that the letter, released Wednesday, requires New York to submit a plan detailing how it will increase oversight of managed care plans' billing for seniors' long-term services.
"If New York can't produce a corrective action plan, the question shifts from how to fix it to whether it can be fixed at all and should this even continue," Brillman said at the briefing. "The governor needs to take a hard look and make hard decisions not around the margins. This requires bold and serious action." He said New York spends more on Medicare and Medicaid programs per resident than any other state, to the tune of $126 billion per year.
CMS Deputy Director Kim Brandt said she conducted audits of 15 social adult day care centers (SADCs) and found pre-filed Medicare and Medicaid billings for listed individuals who were not participants at the centers. Brillman said one center had also filed claims requesting wheelchairs and disability aid: "There were no wheelchairs there," he said, adding that the SADCs do not provide medical care at all.
The warning letter follows the October 20 searches of more than 100 social adult day care providers across New York City by federal, state and local agents. Social adult day care is a non-medical benefit approved and jointly funded by CMS and the state, serving about 45,000 Medicaid members statewide at an annual cost of more than $500 million; Flushing in Queens and Brooklyn's Eighth Avenue corridor are among New York's largest Chinese communities, and many of the seniors served by such centers are Chinese-speaking. CMS Administrator Dr. Mehmet Oz visited adult day care centers in Queens on October 20 and personally delivered warning letters. (GSM, from reporting on the CMS October 21 briefing and Bloomberg Law, October 21; GSM published its main enforcement story on this matter on October 21)
Published by GSM · USA (original Chinese edition)
Photo: 图：纽约皇后区法拉盛缅街站（长岛铁路）站台（资料图）。照片：Pacific Coast Highway，公共领域，经Wikimedia Commons。The platform at Flushing-Main Street station (Long Island Rail Road) in Queens, New York (file photo). Photo: Pacific Coast Highway, public domain, via Wikimedia Commons.
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