Was there health care fraud discovered in New York
Executive summary
Yes — multiple, significant health care fraud schemes have been uncovered and prosecuted in New York in recent years: federal strike‑force actions and district prosecutions alleged billions in fraudulent billing and produced dozens of indictments and settlements, while state enforcement has recovered millions and public reporting has flagged systemic abuse in programs such as CDPAP (Consumer Directed Personal Assistance Program) [1] [2] [3] [4].
1. Federal national takedowns exposed massive schemes and New York was a focal point
A coordinated 2025 national Health Care Fraud Takedown charged hundreds of defendants across the country and included major actions in New York: the Eastern District of New York announced 15 defendants charged with schemes that allegedly billed Medicare, Medicaid and other programs more than $10.6 billion, including an “Operation Gold Rush” case in EDNY where 11 defendants tied to a transnational criminal organization were indicted in what DOJ called the largest health‑care‑fraud case by loss amount ever charged by the Department of Justice [1] [5]. Separately, the Western District of New York reported prosecutions tied to alleged durable medical equipment (DME) fraud and named doctors accused of billing Medicare roughly $29.6 million in one DME matter [2].
2. State enforcement and civil recoveries show parallel problems at the local level
New York Attorney General Letitia James’ office publicized civil enforcement that recovered money from fraudulent Medicaid billing: her office secured over $13 million from 25 transportation providers accused of submitting false Medicaid trip claims, including nonexistent rides and inflated mileage [3]. The New York State Office of the Medicaid Inspector General (OMIG) maintains hotline and reporting mechanisms for provider fraud, signaling an ongoing state‑level infrastructure for uncovering and referring allegations for investigation [6] [7].
3. Program‑specific reporting suggests deep, long‑running abuse — but figures vary by source
Multiple news outlets and specialty sites have reported steep losses tied to CDPAP and other home‑care channels in New York, with some outlets citing as much as $1.2 billion lost to scammers and middlemen and describing pervasive billing for services when patients were hospitalized, dead, or cared for in two places at once [8] [4]. Prosecutors and investigative reporting point to serial schemes — for example, the 2023 conviction and prison sentence for a Brooklyn executive who allegedly stole roughly $100 million via fraudulent home‑health claims — but the exact universe of total losses and how much is fraud versus waste is presented differently across sources [4].
4. Criminal cases illustrate methods and scale: kickbacks, false orders, sham companies
The charged schemes and settlements describe common tactics: kickbacks and bribes tied to adult‑day‑care and home‑health billing, sham orders for DME without examination, fraudulent certifications, and money‑laundering conduits. DOJ and HHS‑OIG materials on the EDNY indictments and the WDNY prosecutions outline these specific allegations in the federal filings [1] [2] [5]. State enforcement actions likewise allege fabricated transportation trips and illicit middleman billing [3].
5. Caveats, competing narratives and limits of available reporting
While federal indictments and state settlements are documented and public, media amplification has produced a range of loss estimates and emphatic characterizations — some outlets frame CDPAP as “one of the most abused programs” and others compare New York losses to other states in sensational terms; these summaries rely on selected prosecutions and investigative snapshots rather than a single audited figure for total fraud [8] [4]. Legal commentary also stresses that prosecutions can hinge on intent and evidentiary details, meaning alleged losses in charging documents are not identical to final recoveries or convictions [9] [10].
6. Bottom line: documented fraud discovered — enforcement active, but scope debates continue
Documented health‑care fraud has been discovered, charged, and in many cases settled or litigated in New York at both federal and state levels — from multi‑defendant federal indictments tied to billions in alleged billing to state recoveries in the millions and high‑profile convictions in the tens or hundreds of millions [1] [2] [3] [4]. At the same time, public debate and reporting diverge over the programmatic scale of fraud versus systemic waste, and official totals vary by agency and outlet, so the exact aggregate loss figure for New York remains contested in public reporting [8] [4] [5].