Overview
- Administrator Dr. Mehmet Oz sent Gov. Kathy Hochul a formal letter with roughly 50 questions on provider screening, cost controls and fraud prevention, copying Health Commissioner James McDonald, Medicaid Director Amir Bassiri and acting Medicaid Inspector General Frank Walsh Jr.
- CMS cited New York’s average Medicaid spending of $12,528 per beneficiary, about 36% above the national average, and said spending per resident is nearly 80% higher in a program covering more than 6.8 million people.
- The review focuses on rapid growth and potential abuse in personal care, home care, adult day care, non-medical transportation—up 121% in recent data—and certain mental health services.
- Oz pointed to Justice Department prosecutions, including guilty pleas in a $68 million home-care billing scheme, as evidence of program-integrity vulnerabilities.
- The move extends a federal fraud crackdown that already paused about $259 million in Minnesota Medicaid reimbursements and drew a state lawsuit; Hochul called the New York action politically targeted while pledging to address actual fraud.