Trump administration admits error in New York Medicaid fraud probe

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President Donald Trump’s administration acknowledged it made a significant error in figures it used to help justify a fraud probe into New York’s Medicaid program, according to an Associated Press report. The dispute centered on how many Medicaid enrollees received personal care services—help with basic activities such as bathing, grooming and meal preparation—and it emerged after CMS corrected the underlying calculation.

CMS administrator Dr. Mehmet Oz had previously pointed to the higher figure in a social media video and in communications tied to the investigation, framing it as evidence that New York’s Medicaid use was unusually high. Oz said that Medicaid last year provided personal care services to some 5 million people, which he characterized as approaching “nearly three-fourths” of New York’s 6.8 million Medicaid enrollees.

CMS spokesman Chris Krepich later told the AP that the actual number of New Yorkers who used personal care services last year was about 450,000, or between 6% and 7% of total enrollees. Krepich said the agency misidentified how New York applied billing codes and that CMS had refined its methodology.

Krepich said the investigation was still under way even after the correction and that CMS continued to have concerns about New York’s oversight of personal care services. In an emailed statement, he said CMS was “committed to ensuring its analyses fully reflect state-specific billing practices” and that it would work with New York to validate data and strengthen program integrity oversight.

Fiscal Policy Institute senior health policy adviser Michael Kinnucan said the mismatch should have been resolved quickly. “These numbers could have been cleared up in a phone call, so it’s really slapdash,” Kinnucan said, describing his analysis of the issue as part of a broader critique of how CMS approaches anti-fraud efforts.

New York health officials and Gov. Kathy Hochul’s administration disputed Oz’s initial characterizations. Kathleen Downes, a Medicaid personal care recipient in Nassau County who has quadriplegic cerebral palsy, said Oz’s comments about families normally providing such help were insulting. “He’s assuming that everybody wants to and can just do it for free forever,” Downes said, adding that she hires both her mother and outside assistants so her mother does not shoulder unpaid caregiving full time.

In addition to the corrected personal care utilization figure, Oz made other claims about New York that advocates said were inaccurate. In the video, Oz said New York had made personal care eligibility “more lenient” by allowing problems such as being “easily distracted” to qualify for a personal care assistant.

Rebecca Antar, director of the health law unit at the Legal Aid Society, said the opposite was true after a rule change that took effect last September. Antar said being “easily distracted” did not appear among the program’s requirements, while Krepich said Oz was referring instead to whether New York’s standard for personal care services was “sufficiently rigorous.”

The AP reported that CMS had raised additional flags about New York’s program, including that it spends more per beneficiary and per resident than the average state and that it has high personal care spending and a large personal care aide workforce. Cadence Acquaviva, a senior public information officer for the New York Department of Health, said Oz’s mischaracterizations were “a targeted attempt to obscure the facts,” and Hochul’s spokesperson Nicolette Simmonds said the “initial claim by CMS was patently false” and that CMS had now admitted its mistake.

The New York probe fits into a wider federal anti-fraud push that has also looked at other states, the AP reported. The effort followed an executive order creating an anti-fraud task force across federal benefit programs led by Vice President JD Vance, including a move in which Vance temporarily halted $243 million in Medicaid funding to Minnesota over fraud concerns—an action Minnesota later sued over, according to the AP report.

Kinnucan said he worried that the administration’s approach could politicize what he described as a technical question of oversight and accuracy. He said he wanted stakeholders to work collaboratively on fixing problems rather than treating fraud as “this political football.”