Adult Day Health Care (ADHC) services play a critical role in New York’s healthcare ecosystem. These centers provide essential services to elderly and disabled populations who need daytime supervision, medical oversight, and social support while allowing them to remain in their communities. However, with the rise of Medicaid billing and increasing government expenditures, Adult Day Care Centers have come under growing scrutiny from law enforcement authorities—particularly the New York State Attorney General (NYS AG).
In recent years, the NYS AG’s Medicaid Fraud Control Unit (MFCU) has launched aggressive investigations targeting adult day care centers suspected of fraud, waste, and abuse. These investigations often center on alleged false billing, kickback arrangements, unnecessary services, and licensing violations. Providers operating in Brooklyn, Queens, the Bronx, and other parts of New York City are especially vulnerable to these audits and investigations, given the high concentration of Medicaid recipients and day care facilities.
The consequences of being caught in the crosshairs of a NYS AG investigation are severe. These cases can result in civil penalties, criminal charges, license revocation, exclusion from Medicaid, and public reputational harm. At Norman Spencer Law Group, we represent adult day care providers at every stage of an investigation—from early audits to criminal prosecution—and help clients respond strategically, protect their rights, and ensure business continuity.
The Role of the NYS Attorney General in Healthcare Enforcement
The New York State Attorney General, through its Medicaid Fraud Control Unit (MFCU), is the primary agency responsible for investigating and prosecuting healthcare fraud involving the state’s Medicaid program. MFCU operates under the broader Health Care Bureau within the Office of the Attorney General (OAG), and its mandate includes rooting out abuse, fraud, and criminal conduct among healthcare providers—including Adult Day Health Care (ADHC) programs.
The MFCU’s jurisdiction includes both civil and criminal enforcement. Investigations may stem from whistleblower complaints, referrals from the Office of the Medicaid Inspector General (OMIG), audits from the Department of Health (DOH), or data analytics that flag suspicious billing trends. These investigations are far-reaching and can include subpoenas for records, unannounced inspections, and interviews of staff and clients.
In addition to targeting outright fraud (such as billing for services not rendered), the NYS AG is also focused on more nuanced regulatory violations, such as failing to meet state licensing requirements, providing services without proper staffing, or enrolling ineligible participants. What might appear to be a clerical error or compliance issue can easily escalate into a formal investigation with devastating consequences.
The NYS AG has a powerful set of legal tools at its disposal, including the authority to bring actions under the New York False Claims Act, pursue civil recoveries, and coordinate with federal agencies when criminal activity is suspected. Because of this broad enforcement reach, even innocent providers can quickly find themselves overwhelmed by legal complexity and government pressure.
At Norman Spencer Law Group, we understand the tactics the NYS AG uses and the standards by which they evaluate day care centers. Our legal team works with providers across the state to anticipate issues, respond to inquiries, and mount effective defenses to preserve licensure, avoid liability, and prevent criminal exposure.
Common Allegations Against Adult Day Care Centers in NY
Adult Day Health Care (ADHC) centers in New York face a wide array of allegations when under investigation by the NYS Attorney General. These allegations often stem from perceived violations of Medicaid billing regulations or licensing requirements and may arise from internal audits, whistleblower reports, or data analytics systems designed to detect anomalies in claims. The most common allegations include:
Billing for Services Not Rendered
This often includes billing for patients who were not actually present, exaggerating the scope of services, or falsifying documentation. Even unintentional documentation errors can be interpreted as deliberate fraud.
Enrolling Ineligible Participants
Some centers are accused of enrolling individuals who do not meet eligibility requirements for ADHC services in order to increase billings.
Kickbacks and Referral Schemes
The NYS AG aggressively investigates allegations of illegal kickbacks offered to patients or third parties in exchange for referrals, in violation of state and federal anti-kickback laws.
Unlicensed or Unqualified Staff
Facilities must comply with staffing ratios and ensure all personnel are properly licensed. Investigators may allege that services were delivered by unqualified individuals or that staffing levels were insufficient.
Failure to Meet Program Standards
Regulations require proper care plans, documentation, and oversight. Alleged failures in these areas—even when unintentional—can lead to charges of systemic fraud.
Norman Spencer Law Group works to show that many of these issues stem from misunderstandings, evolving rules, or training gaps—not criminal intent.
How Investigations Begin: Red Flags and Enforcement Triggers
Billing Irregularities
The state uses data analytics to detect abnormal billing patterns, high service volumes, or discrepancies that can flag providers for investigation.
OMIG Audits and Referrals
OMIG plays a major role in enforcement. If it uncovers issues during an audit, it may refer the case to the NYS AG for further action.
Whistleblower Complaints
Former employees, competitors, or other insiders may submit qui tam complaints under the New York False Claims Act. Even unverified tips can trigger investigations.
Patient or Family Complaints
Allegations of poor care, improper billing, or neglect from patients or their families can lead to scrutiny and formal probes.
Federal Collaboration
When centers bill both Medicare and Medicaid, investigations may involve federal agencies like HHS-OIG or the FBI.
Norman Spencer Law Group provides immediate response plans and representation to minimize exposure from these early warning signs.
Legal Risks for Adult Day Care Centers
Civil Penalties
Violations of the New York False Claims Act can lead to treble damages and substantial per-claim fines. Even minor documentation issues can have major financial consequences.
Criminal Charges
Criminal allegations may include:
- Healthcare fraud
- Grand larceny
- Falsifying records
- Offering false instruments
- Conspiracy
Convictions may result in prison, fines, exclusion from Medicaid, and lasting damage to reputations and careers.
Regulatory Actions
Licensing suspensions, terminations from Medicaid programs, and other administrative sanctions are common—even without a criminal conviction.
Collateral Damage
Investigations often bring media attention, insurance issues, lawsuits, and loss of professional licenses.
Norman Spencer Law Group helps clients anticipate these risks and respond strategically to mitigate them.
Proven Defense Strategies for Adult Day Care Providers
Immediate Legal Response
We initiate rapid-response internal audits to determine the scope of exposure and prepare for defense.
Disputing Investigative Assumptions
Many cases are based on flawed data or unclear regulations. We challenge overbroad conclusions and reframe the evidence.
Voluntary Disclosures
When appropriate, we assist clients in making proactive disclosures to demonstrate cooperation and avoid prosecution.
Negotiated Settlements
We work to resolve matters early with reduced penalties and minimal public exposure.
Litigation Readiness
Our attorneys are trial-ready and have a strong track record in defending healthcare clients in complex prosecutions.
Regulatory Representation
We guide clients through licensing board matters, Medicaid reentry, and other administrative challenges.
Why Adult Day Centers Trust Norman Spencer Law Group
Deep Experience
Our attorneys understand Medicaid rules, OMIG audits, and state healthcare regulations better than most. We’ve represented providers across New York.
Results-Oriented Approach
We’ve helped clients avoid criminal prosecution, secure favorable settlements, and protect their operations.
Multidisciplinary Team
We work with forensic billing experts, former regulators, and medical consultants to build a comprehensive defense.
Client-Focused Service
We pride ourselves on accessibility, clarity, and transparency. Our clients are informed, supported, and empowered throughout the process.
Credibility with Prosecutors
Our reputation for honest, strategic advocacy often allows us to resolve cases more efficiently and discreetly.
Moving Forward with Confidence
NYS Attorney General investigations into adult day care centers are growing in number and complexity. Even honest providers can become targets due to billing anomalies, whistleblower complaints, or misunderstandings of complex Medicaid regulations. The stakes are high—criminal charges, civil liability, and reputational harm are all very real possibilities.
If your adult day care center is under investigation—or if you suspect you’re at risk—the time to act is now. Delaying a response only increases the danger of escalation. Norman Spencer Law Group has the tools, experience, and determination to protect your business, your license, and your future.
Let us help you navigate these challenges with clarity, confidence, and strength.
