New York Cracks Down on Social Adult Day Care Fraud and Reviews the Program’s Future

New York’s social adult day care sector faces intensified scrutiny following Governor Kathy Hochul’s announcement of a coordinated state and federal Medicaid fraud crackdown. The announcement also raises a broader question: whether the benefit should be reformed or eventually phased out.

CBS New York reported law enforcement operations in Brooklyn, Queens and Staten Island linked to alleged healthcare fraud.

Investigations concern alleged wrongdoing. They do not establish guilt or justify treating every provider as if it has committed fraud.

Stronger payment oversight—and a review of the benefit

According to the published announcement, health plans will be required to review social adult day care claims before payment and pursue payment suspensions. The Department of Health must submit recommendations by December 31, 2026, including options for reform or phasing out the benefit and transitioning participants to alternative services.

No statewide end date for existing services was announced. A phaseout remains an option under review. The announcement also states that the moratorium on new SADC providers remains in effect until January 2027 and may be extended.

What social adult day care provides

Social adult day care, commonly abbreviated SADC, supports adults who need assistance functioning safely during the day. Programs provide supervision, social activities, personal care and nutrition in a protective setting, according to NYC Aging.

For participants, these services can provide structure and opportunities to interact with others. For family caregivers, a dependable daytime program can help make an at-home care arrangement manageable.

NYC Aging also distinguishes registration from approval of service quality: city registration is required, but it does not itself constitute a license, certification or determination that a program delivers appropriate care.

Oversight concerns predate today’s announcement

A February 2026 State Comptroller report identified problems involving payment documentation, occupancy limits and participant service plans.

Auditors found $672,147 in claims at three programs unsupported by attendance records or other documentation. They also identified $285 million in questionable payments for services after providers had been terminated from at least one of the six managed long-term care networks reviewed. Those findings should not be described as proof that the entire amount represented criminal fraud.

The findings illustrate why oversight must connect each claim to the participant, the service delivered, the provider’s capacity and supporting records.

Health plans already have oversight responsibilities

New York’s MLTC Policy 25.05, effective September 8, 2025, establishes enhanced oversight requirements for MLTC Partial Capitation and Medicaid Advantage Plus plans. It does not apply to PACE plans.

The policy requires verification of site-level provider identifiers, review of occupancy documentation, examination of attendance and service records, and confirmation that participant service plans and staff training meet applicable standards. Plans must retain documentation of their reviews and required corrections.

These responsibilities make oversight an ongoing process. Collecting documents when a provider joins a network does not establish that every subsequent claim accurately reflects services delivered.

Marton Care IPA’s commitment to safeguards across all lines of business

Marton Care IPA is building its provider network to include social adult day care providers and is ready to implement safeguards and fraud prevention across all lines of business.

As the network develops, the aim is to make accountability part of participation from the beginning, with controls appropriate to each provider type and service.

Areas for implementation can include:

• Provider verification: Reviewing ownership, required licenses or certifications, registrations, provider identifiers and relevant site documentation.
• Exclusion screening: Checking applicable exclusion sources and establishing ongoing monitoring.
• Service verification: Connecting authorizations, attendance or visit records, service plans and supporting documentation.
• Billing review: Flagging duplicate claims, unexplained overlaps, unsupported services and activity inconsistent with documented capacity.
• Follow-up and accountability: Maintaining audit trails, providing compliance education and establishing clear processes for reporting concerns and correcting deficiencies.

These are areas for implementation as the network develops. The commitment extends across Marton Care IPA’s lines of business, with safeguards adapted to the services involved.

Responsible providers should be able to demonstrate the care they deliver. Health plans should have reliable information to evaluate that care. Patients and families should be able to understand what services were authorized and provided.

What families and providers should watch next

Families can ask their center and managed long-term care plan whether there is any actual change to their authorized services and whom to contact if arrangements are affected.

Providers should follow written state and health plan instructions as they are issued. Any eventual changes must be assessed against the policy adopted, including its effective dates and transition arrangements.

For participants who depend on daily supervision, personal care and social connection, continuity of support deserves attention alongside payment integrity.