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Medicaid Monitor
Friday, November 6, 2026 · Updated 1:03 PM MT · 37 stories today
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Medicaid Monitor
Around the States / New York · 37 stories todayPRO
Around the States · New York

New York

4 stories this week from 3 sources

Top New York stories this week

New York OPWDD Finalizes Updated Self-Direction Documentation Rules

New York's Office for People With Developmental Disabilities finalized revised administrative directives on Oct. 30 governing Individual Directed Goods and Services (IDGS) within its Self-Direction program. The updated guidance, ADM #2015-05R2 and a companion ADM #2019-07R, revises requirements for approval, payment, Medicaid reimbursement and documentation of IDGS, along with related Fiscal Intermediary service documentation standards.

Medicaid MonitorNov 3, 2026

NY Dentist Charged in $300K Medicaid Fraud Scheme

A Hicksville dentist, Suleman Nasimi, and his Queens practice, Tooth Fresh Meadows, face felony charges over allegations that Medicaid paid more than $300,000 for dental services that were never provided, according to a September 28 News 12 Long Island report cited by Rivkin Radler LLP. The alleged fraud spans January 2020 through August 2024.

Medicaid MonitorNov 2, 2026

Latest

  1. Published Nov 4

    Mount Sinai Pharmacy Uses AI to Manage GLP-1 Demand Surge

    Medicaid Monitor
  2. Published Oct 29

    New York Focus Explains How County Legislatures Administer Medicaid

    Medicaid Monitor
  3. Published Oct 28

    New York Candidates Diverge on Managing Federal Medicaid Cuts

    As federal Medicaid cuts begin taking effect, New York politicians ahead of the midterms are positioning themselves as defenders of the program, but their approaches to managing the reduced federal funding differ. Some candidates propose shifting more costs to the state budget to preserve coverage, while others focus on administrative efficiencies or eligibility protections. The differing strategies signal how state-level political responses to federal Medicaid funding reductions may play out elsewhere. New York's approach could serve as an early test case for other states facing similar federal funding pressure.

    Why it mattersState Medicaid agencies and health plans in New York face divergent funding and policy scenarios depending on which candidates' approaches prevail, with direct implications for state budget allocations and coverage stability.

    Read at WAER (Syracuse)
    WAER (Syracuse)
  4. Published Oct 27

    New York Proposes Monthly Nursing Home Bed Census Reporting

    In its weekly New York Health Policy Monitor, Isaac Michaels reports that state agencies advanced several regulatory actions affecting health facilities. The Department of Health proposed shifting nursing home bed census reporting from weekly to monthly submissions, while the Education Department finalized rules changing on-site supervision requirements for physical therapist assistants. Separately, the Governor signed legislation lifting residency requirements for Saint Lawrence County's public health and community services director positions, and the Assembly advanced a bill creating a first responder peer support grant program through the Office of Mental Health. The nursing home reporting change is a proposed rule, while the physical therapy supervision change has been finalized.

    Why it mattersNursing home administrators, many of them Medicaid-dependent providers, must prepare to overhaul census data reporting workflows and physical therapy staffing oversight to remain compliant with state licensure and operational rules.

    Read at New York Health Policy Monitor (Buttondown)
    New York Health Policy Monitor (Buttondown)
  5. Published Oct 22

    Opinion Backs Trump Administration's Federal Fraud Crackdown Efforts

    In this opinion piece, the author argues that the Trump administration's ongoing campaign against government fraud is already yielding billions in savings for taxpayers and will continue paying off for years. The commentary praises the anti-fraud push as overdue and credits it with identifying and stopping improper payments across federal programs. No specific Medicaid enforcement action, rule, or dollar figure tied to Medicaid is detailed in the piece. The argument is general and programmatic rather than citing a discrete new policy or legal development.

    Why it mattersStates and health plans should watch for whether this broader anti-fraud push translates into specific Medicaid program integrity directives or enforcement actions.

    Read at New York Post
    New York Post
  6. Published Oct 21

    NY Post Opinion Mocks Hochul's Claimed Fraud Crackdown

    In a New York Post commentary, the author argues that Governor Kathy Hochul's self-presentation as a "fraud warrior" is itself disingenuous, suggesting her fraud-fighting posture is overstated or hypocritical. The piece does not detail specific Medicaid program actions, data, or policy changes, instead using sarcasm to question the governor's credibility on fraud enforcement. No specific legislation, audit, or enforcement action is described in the excerpt provided.

    Why it mattersFor New York Medicaid stakeholders, public skepticism about the sincerity of state fraud-enforcement claims can shape political pressure on program integrity funding and oversight priorities.

    Read at New York Post
    New York Post
  7. Published Oct 21

    CMS Uses New Authority to Expel NY Adult Day Care Providers

    Medicaid Monitor
  8. Published Oct 21

    Staten Island Adult Daycare Operators Charged in $530K Medicaid Fraud

    New York prosecutors charged two Staten Island adult daycare operators, Yangsim Oum and her daughter Juyone Choe, with defrauding Medicaid of more than $530,000 in a scheme dubbed "Operation Golden Grift." The pair allegedly billed Medicaid for services to hundreds of seniors who were never actually served, including beneficiaries who had died or were out of the country at the time billed. The charges were announced Wednesday by the district attorney's office. The case targets fraudulent billing for adult day services covered under New York's Medicaid program.

    Why it mattersThe case underscores Medicaid program integrity risks in adult day health services and signals continued state prosecutorial focus on provider billing fraud affecting LTSS spending.

    Read at New York Post
    New York Post
  9. Published Oct 21

    Federal Agents Raid Brooklyn Adult Day Cares Over Medicaid Fraud

    Homeland Security Investigations agents raided at least two adult day care centers in Brooklyn on Tuesday as part of a federal operation targeting alleged Medicaid fraud, including money-laundering and kickback schemes. Officials said the raids are part of a monthslong crackdown involving some of New York's most vulnerable Medicaid beneficiaries. Gov. Kathy Hochul described the effort as a "massive effort to combat fraud and abuse." No charges or defendants were detailed in the initial report.

    Why it mattersAdult day care providers and their referral partners face heightened federal scrutiny of billing and kickback arrangements, with potential exclusion, clawback, and criminal exposure for those implicated.

    Read at New York Post
    New York Post
  10. Published Oct 21

    CMS's Oz Targets 80-Plus NYC Senior Centers Over Medicaid Billing

    CMS Administrator Dr. Mehmet Oz put more than 80 New York City adult day and senior care centers on notice over suspected Medicaid fraud, citing billing levels he called far higher than they should be. The action signals heightened federal scrutiny of claims submitted by these facilities, which serve elderly and disabled Medicaid beneficiaries needing daily supervision or care. Oz's comments suggest investigations or audits may follow, though the article does not detail a specific enforcement mechanism or timeline. The move reflects broader federal attention to program integrity in Medicaid-funded long-term and adult day care services.

    Why it mattersProviders flagged in the notice face potential audits, clawbacks, or enforcement action that could disrupt billing and operations for facilities serving vulnerable Medicaid-dependent seniors.

    Read at New York Post
    New York Post
  11. Published Oct 14

    Brooklyn Adult Day Care Owner Pleads Guilty to $65M Medicaid Fraud

    Medicaid Monitor
  12. Published Oct 13

    Law Firm Details New York Medicaid Enrollment Changes Beyond Moratorium

    Medicaid Monitor
  13. Published Oct 13

    NYHealth President Urges Primary Care Role to End HIV Epidemic

    Medicaid Monitor
  14. Published Oct 8

    NYC Health Commissioner Outlines City Response to Medicaid Cuts

    Medicaid Monitor
  15. Published Oct 8

    New York Seeks Bronx Exemption from Medicaid Work Requirements

    Medicaid Monitor
  16. Published Oct 8

    NYC Pharmacy Owner Charged in $31M Medicaid Kickback Scheme

    New York Attorney General Letitia James announced charges against a New York City pharmacy owner accused of running a $31 million Medicaid kickback and HIV drug diversion scheme. The scheme allegedly targeted vulnerable Medicaid beneficiaries, using kickbacks tied to HIV medications to defraud the Medicaid program. James called the conduct "despicable" in a statement announcing the charges. Further details on the specific charges and defendants were not provided in the release.

    Why it mattersThe case signals continued state-level enforcement scrutiny of pharmacy billing and specialty drug kickback arrangements that can trigger provider exclusion, clawbacks, and heightened program integrity audits across the Medicaid pharmacy benefit.

    Read at New York Post
    New York Post
  17. Published Oct 7

    Northwestern Mutual Study Finds Few Plan Long-Term Care Finances

    A Northwestern Mutual study finds that 73% of Americans want to age in their own homes, but 54% have not financially planned for long-term care costs. The findings highlight a gap between consumer preference for home-based aging and preparedness to pay for the services needed to achieve it. The study does not describe a policy change or new program, but underscores the financing challenge many families face as they consider long-term services and supports. No effective date or regulatory action is referenced in the findings.

    Why it mattersUnmet private long-term care planning often pushes families toward Medicaid as the payer of last resort once savings are exhausted, increasing pressure on state LTSS budgets.

    Read at New York Post
    New York Post
  18. Published Oct 6

    Hochul Declares Disaster Emergency Over New York Measles Outbreak

    Medicaid Monitor
  19. Published Oct 6

    New York Bills Would Force Insurers to Divest Pharmacy, Provider Holdings

    In its New York Health Policy Monitor, Isaac Michaels reports that state legislative committees are evaluating bills (S9191, S9192) banning vertical integration across health insurers, pharmacy benefit managers, pharmacies, and providers. Non-compliant entities would have three years to divest overlapping ownership and would be barred from receiving payments under the state medical assistance program until the Attorney General confirms the violations are resolved. The same roundup notes a separate proposal to cap state drug reimbursement using the federal maximum fair price, a 90-day provisional practice allowance for master's-level mental health counselors, and newly adopted or proposed state education department rules on pharmacy services, speech-language pathology, school athletic screenings, and immunizations. The bills remain in committee with no vote scheduled yet.

    Why it mattersHealth plans and PBMs with integrated pharmacy or provider ownership in New York face potential loss of Medicaid payment eligibility and forced multi-year divestiture if these bills advance.

    Read at New York Health Policy Monitor (Buttondown)
    New York Health Policy Monitor (Buttondown)
  20. Published Oct 5

    Northwell Health Cuts Jobs for Third Time in a Year

    Medicaid Monitor
  21. Published Oct 5

    NY Providers Warn Medicaid ABA Therapy Rate Cut Threatens Care

    New York autism service providers are warning that a 50% cut to Medicaid reimbursement rates for Applied Behavior Analysis (ABA) therapy will disrupt treatment access for children with autism. Providers say the reduced rate would make New York's Medicaid reimbursement the lowest in the country, threatening the financial viability of ABA practices and provider networks. The cut affects families relying on Medicaid-funded ABA services and the agencies that employ behavior analysts and therapists statewide. Providers are raising concerns publicly as they push the state to reconsider the rate change before it takes effect.

    Why it mattersA reimbursement cut this steep could force ABA providers to close or limit Medicaid caseloads, cutting off access to autism treatment for low-income families across New York.

    Read at WRVO (Oswego/Syracuse)
    WRVO (Oswego/Syracuse)
  22. Published Sep 30

    HHS-OIG Denies Recertification of New York's Medicaid Fraud Unit

    Medicaid Monitor
  23. Published Sep 24

    190,000 New York CDPAP Caregivers File for Union Election with 1199SEIU

    Medicaid Monitor
  24. Published Sep 21

    OIG Finds New York Made Unallowable Capitation Payments for Incarcerated Enrollees

    Medicaid Monitor
  25. Published Sep 17

    NYC Health + Hospitals-Maimonides Merger Clears State Public Health Council

    Medicaid Monitor
  26. Published Sep 11

    New York DOH Rescinds Guidance That Would Have Ended Nursing Home Medicaid for Undocumented Seniors

    Medicaid Monitor
  27. Published Sep 10

    Brooklyn Home Health Owner Sentenced to 76 Months for $64M Medicaid Fraud Scheme

    Medicaid Monitor
  28. Published Sep 4

    CMS Awards New York $76 Million for Regional Health IT Modernization

    Medicaid Monitor
  29. Published Sep 1

    Troy Hospital Keeps Birthing Center Open After Community Opposition

    Medicaid Monitor
  30. Published Aug 20

    EmblemHealth Issues Cease-and-Desist to Mount Sinai Over Government Plan Patient Access

    Medicaid Monitor

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