Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz confronted employees at two New York City senior care centers over alleged Medicaid fraud, questioning their billing practices, a crackdown exclusively reported by Fox News Digital.
Oz, accompanied by top federal health officials, sent warning letters to Kent Senior Care Center and Evergreen Adult Day Care Center in Flushing, Queens, as part of a broader fraud crackdown involving the FBI, the Department of Health and Human Services Office of the Inspector General, the New York Police Department and other agencies.
The letters informed the facilities that their billing practices raised concerns among federal authorities. Oz’s two visits were part of a broader crackdown that saw CMS officials conduct more than 80 visits Tuesday and send warning letters to health care providers across New York City.
Fox News Digital accompanied Oz as he questioned employees about questionable billing records and questioned their explanations of how taxpayer funds were spent.
“The whole experience was fishy,” Oz said in an exclusive interview with Fox News Digital after the interview.
Oz said federal authorities are conducting a broader crackdown that includes arrests, search warrants and efforts to stop some providers from billing Medicaid, although Fox News Digital has not independently witnessed these enforcement actions at the two Queens facilities.
Kent Senior Care declined to comment during a call with Fox News Digital on Tuesday. Evergreen Adult Day Care did not immediately respond to Fox News Digital’s request for comment.
Oz questions senior center director: ‘We don’t believe you’
The first stop was at Kent Senior Care Center around 8:30 a.m., where Olds entered the facility and personally delivered to his supervisor a letter from the federal government informing the business that its billing practices were under review.
“The bill is much higher than it should be,” Oz told the director. “The billing is for more people. It doesn’t look very crowded here.”
The director countered in the exchange that it was still early and more seniors would arrive later in the morning, as Olds questioned whether the agency’s Medicaid billing records accurately reflected its actual attendance.
According to the maximum capacity sign posted on the wall, the space can accommodate 70 people.
“The bills we get seem to be always full,” Oz said.
The director insisted that the facility only charges seniors who actually attend and requires participants to sign attendance sheets.
“You’re receiving this letter from the U.S. government because we don’t believe you,” he told the director.
During the exchange, Oz also questioned why the center’s billing records show seniors attending five days a week, when the director admitted many participants typically only attend two or three days.
The superintendent insists the facility charges based on actual attendance, saying some seniors have higher attendance rates than others.
The confrontation intensified when Olds and other federal officials raised questions about specialized transportation services that charge for seniors who use wheelchairs.
“I don’t see any wheelchairs here,” Oz told the director.
Fox News Digital observed seniors at the facility, including those using walkers, but did not see anyone using a wheelchair during the visit.
Another official said the billing records included charges for specialized wheelchair transportation, raising questions about whether the service was provided and which company was responsible for submitting the charges.
The director said the facility is equipped with wheelchairs for some elderly people who have limited mobility, including those recovering from strokes. He also said staff could have copied messages from previous documents instead of properly updating billing codes for wheelchair use.
“Maybe he just copied and pasted it,” the director said.
During the tour, Olds walked up to several mahjong tables set up at the facility and questioned whether taxpayer dollars were being spent properly on recreational activities provided by the Medicaid-funded program.
“Should American taxpayers pay for people to play mahjong?” Oz asked the director.
The official defended the activity, explaining that mahjong can help older adults exercise their fingers, socialize and improve memory, especially those with cognitive difficulties.
“It’s free to them, not free to the taxpayers,” Oz replied. “Is this where our federal tax dollars for Medicaid should be going? Or life-saving heart surgery? Or, you know, new treatments for cancer?”
Oz expresses concern about seniors entering without registering
Although supervisors insisted that participants record their attendance, Olds raised additional concerns about the facility’s attendance records after observing seniors entering without signing in.
“People just walked in and didn’t sign anything,” Oz said. “When I showed up and he saw what we and my team were doing, he started gathering these documents to sign.”
Oz said the apparent inconsistency further raises questions about whether the agency’s attendance records accurately reflect the fees billed to Medicaid for services.
Fox News Digital also witnessed several seniors entering the Kent Senior Care Center but not immediately signing attendance sheets. Other seniors who arrived later were instructed to sign in.
Social adult day care programs provide structured activities, supervision, meals and social support to eligible older adults. Medicaid reimbursement is dependent on applicable program rules, individual eligibility, and documentation of services provided.
At the second stop, Evergreen Adult Day Care Center, Oz confronted the floor manager about another set of billing discrepancies before checking the facility’s attendance records.
Managers told Oz that about 200 seniors visit the facility on Mondays, Wednesdays and Fridays, and about 150 on Tuesdays and Thursdays, although it’s unclear whether those numbers represent total daily attendance or the number of seniors present at one time.
But Olds questioned those numbers after walking through the facility and observing a significant decrease in crowds.
“So now I see about 25 people in this whole space,” Oz said.
Managers disputed that estimate, explaining that some seniors were attending classes while others left to shop, go to the pharmacy or attend medical appointments.
“The numbers don’t seem to add up,” Oz replied.
Oz also asked the manager about wheelchair-related billing issues, asking how many participants used wheelchairs.
The manager initially said no one was doing this before admitting that a handful of seniors had used them.
“But you said you didn’t, didn’t you?” Oz pressed.
He later discussed the apparent discrepancy with other federal officials accompanying him.
“I’m surprised there are so few people here,” Oz said. “It makes me wonder how they maintain these billing levels.”
The visit took another turn when Oz checked the facility’s attendance book, which he said contained “fraud.”
Fox News Digital observed that the sign-in sheet appeared to contain names entered on October 22 and October 23, dates that had not yet occurred at the time of the visit.
Following the visit, entries dated Oct. 22 and Oct. 23 raised questions about whether the facility was recording attendance ahead of time, although Fox News Digital could not immediately determine whether the entries were complete attendance records or ahead of time schedules.
Oz charges organized crime in connection with NYC Medicaid fraud
Oz said federal authorities believe organized crime networks are taking advantage of Medicaid-funded programs to provide seniors with money to use facilities and then bill the government for services that are not actually provided.
Oz claimed that individuals he described as linked to the “Chinese Mafia” paid some senior citizens $1,000 to $1,200 to participate in fraudulent billing arrangements, although administrators did not identify specific criminal organizations or provide supporting evidence in interviews.
Oz said the federal government has seen significant increases in bills across the industry, claiming annual spending on these projects is approaching $1 billion.
“What we know from the bills here is that there’s no way this business can run the way they claim it can run without any issues,” Oz told Fox News Digital.
“Is this an unconscious mistake? For a hundred times in a row, I don’t think so.”
Oz alleges that proceeds from the fraudulent Medicaid billing scheme were used to fund other criminal activities, including money laundering and human trafficking, although Fox News Digital has not independently verified these connections or established any such connection with the two facilities visited.
“This was truly a criminal club,” Oz said, describing the alleged broader scheme.
He said fraud has accelerated during the COVID-19 pandemic and criticized the previous government for failing to address what he said were rapidly rising spending and questionable billing.
New York Gov. Kathy Hochul acknowledged the crackdown on Tuesday, calling it part of a “large-scale effort to combat Medicaid fraud and abuse” and confirming that state health officials have joined federal and state law enforcement to combat alleged fraud in the community’s adult day care program.
While Oz personally sent warning letters to two facilities in Queens, state, local and federal law enforcement officials simultaneously conducted searches at other locations in New York City as part of a coordinated crackdown.
Specific details about the targeted facilities, individuals involved and evidence found were not immediately released as the investigation is ongoing.