NEW YORK (AP) — President Donald Trump’s administration acknowledged this week that it made a significant error in data used to help justify a fraud investigation into New York’s Medicaid program, an apparent mistake that undermines a federal campaign to address the waste, often in Democratic-led states.
The error, previously acknowledged by the administration to The Associated Press, prompted health analysts to question how much of the Republican administration’s sweeping anti-fraud efforts across the country were based on flawed findings. One of the few mischaracterizations it makes about New York’s Medicaid program, it also reflects a common criticism of Trump’s second administration — that it attacks first and confirms the facts later.
“These numbers could have been cleared up in a phone call, so it’s really a slap in the face,” said Michael Kinnukan, senior health policy adviser at the Fiscal Policy Institute, whose recent analysis has drawn attention to the Trump administration’s false claims.
Last month, the administrator of the Center for Medicare and Medicaid Services. The mistake appeared in comments Mehmet Oz made in a social media video and in a letter to New York’s Democratic governor announcing the fraud investigation.
Oz claimed that New York’s Medicaid program provided personal care services to nearly 5 million people last year, helping people in need with basic activities such as bathing, grooming and meal preparation. That would add nearly three-quarters of the state’s 6.8 million Medicaid enrollees.
“That level of utilization is unheard of,” Oz said in the video, adding that New York “needs to come clean about its Medicaid program.”
But the actual number of New Yorkers who used those services last year was about 450,000, or between 6% and 7% of total enrollments, CMS spokesman Chris Krepich told the AP this week. He said the agency misidentified New York’s approach to enforcing billing codes and then refined its methodology.
“CMS is committed to ensuring its analyzes fully reflect state-specific billing practices and will continue to work closely with New York to validate data and strengthen program integrity oversight,” he said in an emailed statement.
Krepich said the investigation is ongoing because the administration still has concerns about New York’s oversight of personal care services and the Medicaid program and is reviewing the state’s response to last month’s letter. CMS raised other flags about New York’s program, including that it spends more per beneficiary and per resident than the state average, has higher personal care spending and employs so many personal care aides that the job category is now the largest in the state.
Health analysts said the state’s higher spending reflects both higher costs for services in New York and a policy choice to provide stronger home care. Cadence Acquaviva, senior public information officer for the New York Department of Health, called Oz’s initial mischaracterization a “targeted effort to obfuscate the facts.”
“New York State is committed to preserving and protecting important Medicaid programs that provide high-quality services to the New Yorkers who depend on them,” she said.
In a statement, a spokeswoman for Gov. Cathy Hochul said, “CMS’s initial claim was clearly false, and we are pleased that they acknowledged it.”
“Governor Hochul is clear that he has zero tolerance for waste, fraud and abuse in Medicaid or other state programs, and will continue his efforts to root out bad actors, protect taxpayer dollars and protect the critical programs that New Yorkers rely on,” spokeswoman Nicolette Simmonds said.
The New York investigation is part of a larger crackdown
The Trump administration’s investigation into New York comes as it approaches at least four other states, including California, Florida, Maine and Minnesota, with investigations into possible health care fraud. Anti-fraud efforts appear to be expanding as voters worry about affordability in the upcoming midterm elections.
Trump signed an executive order last month to create an anti-fraud task force on federal benefit programs led by Vice President J.D. Vance. As part of that project, Vance announced that the administration would temporarily withhold $243 million in Medicaid funding to Minnesota over fraud concerns, a move that has since been sued by the state.
Kinnukan, an analyst specializing in New York’s Medicaid program, said he worries that the Trump administration’s adversarial approach to targeting fraud in some states will “politicize” the conversation about what should be a team effort.
“We want to think collaboratively between all stakeholders in the program about how we can fix this,” Kinnukan said. “We don’t want this to be a political football fraud.”
Oz made other claims that New York’s attorneys say are false
In his video, Oz made at least two other claims about New York that Medicaid advocates and beneficiaries distorted the facts.
In one example, he said the state recently made its screening for personal care eligibility “more lenient by allowing problems like being ‘easily distracted’ to qualify for a personal care assistant.”
Rebecca Antar, director of the Legal Aid Society’s health law unit, said the opposite was true — that the state tightened its program requirements in a rule change that took effect last September. She said that “easily distracted” was nowhere to be seen between them.
Krepich said the administrator was indicating whether New York’s standard for personal care services was “strict enough.”
“When standards are overly permissive, they risk diverting resources away from people with the highest levels of need and putting long-term pressure on the sustainability of the Medicaid program,” he said.
In the video, Oz also referred to personal care services as “things our families usually do for us, like carrying groceries.”
Kathleen Downes, 33, who has quadriplegic cerebral palsy and uses personal care services in Nassau County, New York, said she was outraged by the notion that all Medicaid beneficiaries had family members willing and able to help.
Downes, who has been disabled since birth and needs personal care help with things like bathing, using the toilet and eating, said she hires her mother and outside helpers for personal care services, so her elderly mother doesn’t have to carry out those tasks. She said her mother worked unpaid labor for years, preventing her from pursuing other career opportunities.
“He assumed that everybody wanted and could do it forever for free,” Downes said. “And that’s not possible for most people.”
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Associated Press writer Anthony Izaguirre contributed to this story.
