# New York Tightens Medicaid Fraud Oversight

New York is coordinating state and federal investigations into suspected fraud involving more than 100 adult social day care providers and strengthening oversight of Medicaid claims. Separately, CMS is requiring New York to submit a plan for stronger oversight of Medicaid managed-care insurers after billing concerns involving adult day-care facilities in Flushing, Queens. State recommendations to Governor Kathy Hochul are due **December 31, 2026**; a moratorium on new adult social day care providers remains in effect through January 2027 and may be extended. No solicitation, contract value, or procurement contact is identified, but the actions could affect providers and contractors supporting Medicaid claims, program integrity, auditing, and managed-care compliance.

- Contractors supporting New York Medicaid programs should assess their ability to support claims reviews, fraud investigations, and managed-care oversight if the state changes its controls or service model.
- Adult social day care providers may face increased payment reviews, possible suspensions, and tighter compliance requirements; the moratorium restricts entry by new providers through January 2027.
- The state’s recommendations are due December 31, 2026. Companies serving the program can use this timeline to assess operational and compliance exposure; the signals do not identify a procurement opportunity or proposal deadline.

**Jurisdictions:** federal, sled
**Industries:** Healthcare
**Topics:** Regulatory Compliance
**Published:** October 21, 2026

### Government Entities
- Centers for Medicare & Medicaid Services (CMS)
- New York State Department of Health (NYSDOH)
- New York State Office of the Medicaid Inspector General (OMIG)
- New York State Attorney General’s Medicaid Fraud Control Unit (MFCU)
- U.S. Department of Health and Human Services Office of Inspector General (HHS OIG)

### Key Quotes
> Estamos comprometidos a evaluar todas las opciones disponibles y a presentar recomendaciones que protejan a los beneficiarios de Medicaid, preserven el acceso a servicios adecuados y aseguren que el dinero de los contribuyentes se utilice de manera eficaz y responsable.
> — Amir Bassiri, New York State Medicaid Director

> Durante todo este proceso, nuestra prioridad seguirá siendo proteger a las personas mayores y garantizar la continuidad de su atención.
> — Dr. James McDonald, New York State Health Commissioner

### Sources
- [La Gobernadora Hochul Anuncia una Iniciativa Conjunta para Proteger el Dinero de los Contribuyentes y Combatir el Fraude en el Programa de Centros de Día Social para Adultos | Governor Kathy Hochul | New York State](https://www.governor.ny.gov/news/la-gobernadora-hochul-anuncia-una-iniciativa-conjunta-para-proteger-el-dinero-de-los) - NY