Trump Administration Acknowledges Major Error in New York Medicaid Fraud Accusations

The Trump administration acknowledged a major error in its fraud investigation of New York's Medicaid program, with CMS Administrator Dr. Mehmet Oz claiming 5 million New Yorkers used personal care services when the actual number was about 450,000—roughly 6-7% of the state's 6.8 million Medicaid enrollees. CMS also misidentified New York's billing code approach and falsely claimed the state loosened eligibility requirements, when New York actually made requirements more stringent in September. The investigation is part of broader anti-fraud efforts targeting at least five states, mostly Democratic-led, including Minnesota where the administration temporarily halted $243 million in funding, prompting a lawsuit. New York defends its higher-than-average Medicaid spending as reflecting both high service costs and a deliberate policy choice to provide robust at-home care, with personal care aide being the state's largest job category.

Acknowledgment of Statistical Error in Medicaid Fraud Accusations

• ▪The actual number of New Yorkers who used personal care services in the previous year was about 450,000
• ▪The 450,000 personal care services users represented between 6% and 7% of New York's total Medicaid enrollees
• ▪The Centers for Medicare & Medicaid Services misidentified New York's approach to applying billing codes
• ▪Dr. Mehmet Oz is the administrator of the Centers for Medicare & Medicaid Services
• ▪The Trump administration acknowledged making a significant error in figures used to justify a fraud probe into New York's Medicaid program
• ▪Chris Krepich is a spokesman for the Centers for Medicare & Medicaid Services
• ▪Dr. Mehmet Oz claimed that New York's Medicaid program provided 5 million people with personal care services in the previous year
• ▪New York's Medicaid program had 6.8 million enrollees
• ▪Michael Kinnucan is a senior health policy adviser at the Fiscal Policy Institute

Broader Federal Anti-Fraud Campaign Across Multiple States

• ▪The Trump administration approached at least five states with investigations into potential health care fraud: California, Florida, Maine, Minnesota, and New York
• ▪Vice President JD Vance announced the administration would temporarily halt $243 million in Medicaid funding to Minnesota over fraud concerns
• ▪President Donald Trump signed an executive order to create an anti-fraud task force across federal benefit programs led by Vice President JD Vance
• ▪Minnesota sued over the temporary halt of $243 million in Medicaid funding

Additional Disputed Claims About New York's Medicaid Program

• ▪Rebecca Antar is director of the health law unit at the Legal Aid Society
• ▪Dr. Mehmet Oz claimed that New York recently made its screening for personal care eligibility more lenient by allowing problems like being easily distracted to qualify for a personal care assistant
• ▪New York made its personal care program requirements more stringent in a rule change that went into effect in September
• ▪New York's high Medicaid spending reflected both high costs for services in New York and a policy choice to provide robust at-home care

Impact on Medicaid Beneficiaries and Program Integrity Concerns

• ▪Kathleen Downes is a 33-year-old who has quadriplegic cerebral palsy and uses personal care services in New York's Nassau County
• ▪The Centers for Medicare & Medicaid Services probe into New York's Medicaid program was ongoing as of the article's publication
• ▪The Centers for Medicare & Medicaid Services has concerns with New York's oversight of personal care services and the Medicaid program

Perspective of New York State officials and advocates

• ▪New York's high Medicaid spending reflected both high costs for services in New York and a policy choice to provide robust at-home care
• ▪New York made its personal care program requirements more stringent in a rule change that went into effect in September

Perspective of Dr. Mehmet Oz and the Centers for Medicare & Medicaid Services

• ▪The Centers for Medicare & Medicaid Services probe into New York's Medicaid program was ongoing as of the article's publication
• ▪The Centers for Medicare & Medicaid Services has concerns with New York's oversight of personal care services and the Medicaid program

Perspective of Critics of the Trump administration's anti-fraud efforts

• ▪Minnesota sued over the temporary halt of $243 million in Medicaid funding