Disabilities Beat: What New York has to say about Dr. Oz’s Medicaid fraud allegations

Last month, Dr. Mehmet Oz, the administrator for the U.S. Centers for Medicare and Medicaid Services, or CMS, made a bold claim.

“The numbers coming out of New York’s Medicaid program don’t add up,” Dr. Oz said in a social media video accusing New York State of Medicaid fraud. “Last year, five million Medicaid beneficiaries — that’s nearly three out of four Medicaid enrollees — received these personal care services.”

Dr. Oz was right. That number doesn’t add up.

“The CMS number was off by a factor of 10, or more than 10, as they now acknowledge,” said Michael Kinnucan, the health policy director for Albany-based thinktank Fiscal Policy Institute.

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“I think anyone familiar with New York State’s Medicaid program and long-term care immediately looked at that number and said, 'Something strange is going on here,'” Kinnucan told BTPM NPR.

Last week, CMS admitted to the Associated Press the agency made an error when estimating how many New Yorkers use personal care services.

The “five million Medicaid beneficiaries” statistic was also used in a letter from CMS to New York Governor Kathy Hochul, a Democrat, alleging the state was committing Medicaid fraud.

“The number is not around five million, it’s around 400,000,” Kinnucan, who studies Medicaid data in New York, said. “And so for them, both, to make this error and also to not catch it, not do sort of a sanity check on it, is really surprising.”

CMS admitted the actual number was around 450,000. However, the agency didn’t apologize or explain how it came up with the five million figure.

Kinnucan was first to point out the math was likely wrong, and he thinks he knows how CMS did the math.

“It’s just sort of a pretty basic data error to believe that you can just sort of sum a bunch of monthly columns to get an annual column,” Kinnucan said.

Kinnucan believes, based on spreadsheets CMS posted and the math he’s done, that, essentially, CMS added wrong.

Each month, each company managing personal care services reports the total unique beneficiaries they served. Kinnucan thinks CMS added up the beneficiaries each month to get a year or time period total. The problem is those beneficiaries aren’t new people each month. It’s often the same people.

“If you had a spreadsheet showing the number of unique people who had used your toothbrush in each month of the year, it would say January, one person, February, one person, and so forth,” Kinnucan said, giving an analogy. “And you couldn’t then add that column up and say 12 unique people used your toothbrush. It was the same person each month in the whole year.”

When Kinnucan first published his belief that CMS was wrong, he used data available for Western New York Independent Living, a local independent living center that used to manage consumers and their aides in 2024, as an example.

WNYIL reported roughly 1,000 people each month. So, if you added them up over 12 months, you would have around 12,000 beneficiaries. But WNYIL didn’t have 12,000 beneficiaries. Those roughly 1,000 people each month were usually the same people, because you don’t often change your provider for personal care services.

“Not only am I chief policy officer at WNYIL, but I was a consumer of WNYIL’s fiscal intermediary,” said Todd Vaarwerk. “And I can tell you, I didn’t leave the fiscal intermediary every month and come back in so that I could be counted again.”

Vaarwerk believes Kinnucan is right. He also believes other claims from Oz and CMS are inaccurate.

“Personal care services, these help Medicaid patients do something that our families would normally do for us, like carrying groceries,” Oz said in the video. “New York State made this screening even more lenient by allowing problems like being easily distracted to qualify for a personal care assistant.”

Last week, BTPM NPR obtained a letter the state sent to CMS a week before it admitted its error, pointing out its allegations were incorrect. That letter was also the requested response to CMS’ allegations.

In it, New York showed statistics emphasizing that accessing personal care services requires significant need.

“We can’t turn around and say the parameters currently are not stringent,” Vaarwerk said of the requirements to get personal care services.

In 2025, New York increased how many activities of daily living (ADLs) — such as bathing, cooking and dressing — a person must be unable to do to qualify for personal care services. Most people now need to be unable to do three or more tasks to qualify.

But according to the state’s letter, “between 75% and 80% of recipients need support with an average of seven to nine ADLs.”

What Oz could be referring to — “being easily distracted” — might be tasks known as independent activities of daily living (IADLs), such as making a budget, using the phone and going to the store. Again, the majority of personal care recipients are unable to do a lot of these tasks, not just one.

The state reports between 65% and 70% of recipients of both types of personal care in New York have an average of 14 to 16 IADLs they cannot do.

The state and Vaarwerk also point out these programs reduce nursing home costs.

“Advocates for people with disabilities have been very clear about the fact that services in the community are cheaper and more effective than services provided in an institution,” Vaarwerk told BTPM NPR.

Nursing Facility Level of Care (NFLOC) scores, determine if a person would be eligible for nursing home care. A score over five indicates they would — and the state’s provided graph to CMS shows the majority of recipients have a score of over five, with many closer to 20.

According to New York’s letter to CMS, in 2025 the average spending on personal care per capita in the state was $32,951. The average for nursing homes was $56,082.

Another statistic many in the disability community point to is the average annual rate for a person to be in a nursing home. In Western New York, it’s $165,180.

According to the state’s letter, at the higher end of the average hours used on personal care services, it’s about 30 hours a week. In upstate New York, the minimum wage for home care is currently $18.65. So, without any benefits, one could estimate the average home care aide to make about $29,094 in Western New York.

That’s over $100,000 in cost savings.

New York also made significant changes to its largest home care program, the Consumer Directed Personal Assistance Program, or CDPAP, in 2025 to, according to the state, improve oversight and reduce costs.

“This contract award ensures the state will continue to provide necessary care options through the Consumer Directed Personal Assistance Program, as well as strengthening this vital program to deliver uninterrupted services and care to those in need, greater fiscal accountability, and timely payments to provider,” State Health Commissioner Dr. James McDonald said in 2024, when the state announced Public Partnerships LLC would take over as the sole company to pay workers in 2025.

“Governor Hochul continues to protect those who are served by this program from waste and abuse,” Dr. McDonald added.

However, New York’s changes have left many with concerns about their ability to access the program under a new single company managing their services.

Vaarwerk said this goes back to a central issue disabled people have faced with changes to, and investigations into, Medicaid.

“These are government officials making investigations and making recommendations and modifying Medicaid plans without even taking two minutes to talk to the affected consumers about how their life would change,” Vaarwerk said.

Many people with disabilities also want to see their tax dollars used effectively.

Vaarwerk points out if the state or the federal government want to make these programs more cost effective, they should talk to the users.

“If you truly believe about effective cost-containment, you’re going to be talking about changes that are going to affect my community and my life,” Vaarwerk said. “So, how about getting some of those people involved in that conversation?”

TRANSCRIPT

This transcript was created by a contractor and may be updated over time to be more accurate.

Emyle Watkins:

Hi, I'm Emyle Watkins and this is the Disabilities Beat.

Dr. Mehmet Oz:

The numbers coming out of New York's Medicaid program, don't add them.

Emyle Watkins:

You might've heard this claim from Dr. Mehmet Oz, the administrator for the US Centers for Medicare and Medicaid Services or CMS last month.

Dr. Mehmet Oz:

Last year, five million beneficiaries, that's the only three out of four Medicaid enrollees, received these personal care services.

Emyle Watkins:

And he's right, that number actually doesn't add up.

Michael Kinnucan:

The CMS number was off by a factor of 10.

Emyle Watkins:

Michael Kinnucan is the health policy director at the Albany think-tank Fiscal Policy Institute.

Michael Kinnucan:

I think anyone sort of familiar with New York State's Medicaid program and long-term care sort of immediately looked at that number and said, "Something strange is going on here."

Emyle Watkins:

Last week, CMS admitted their estimate of New Yorkers using personal care services was an error. Dr. Oz also stated that number in a letter to New York's Democrat Governor, Kathy Hochul, alleging the state was committing Medicaid fraud. CMS admitted the actual number was around 450,000 people. However, the agency didn't apologize nor explain how they came up with a five million number. Kinnucan was first to point out the math was likely wrong, and he thinks he knows why.

Michael Kinnucan:

It's just sort of a pretty basic data error to believe that you can just sort of sum a bunch of monthly columns to get an annual column.

Emyle Watkins:

Each month, each company managing personal care services reports the total unique beneficiaries they served. Kinnucan thinks CMS added up the beneficiaries each month to get to a year or time period total. The problem is, those aren't new people each month. It's often the same people.

Michael Kinnucan:

If you had a spreadsheet showing the number of unique people who had used your toothbrush in each month of a year, it would say January, one person, February, one person and so forth. And you couldn't then add that column up and say, "Well, 12 unique people used your toothbrush." It was the same person each month.

Emyle Watkins:

When Kinnucan first published his belief that CMS was wrong, he used Western New York independent living who used to manage home care consumers and their aids in 2024 as an example.

Todd Vaarwerk:

Not only am I chief policy officer at WNYIL, but I was a consumer of WNYIL's fiscal intermediary. And I can tell you, I didn't leave the FI every month and come back in so that I could be counted again.

Emyle Watkins:

Todd Vaarwerk believes other claims from Oz and CMS are also inaccurate.

Dr. Mehmet Oz:

New York State made this screening even more lenient by allowing problems like being easily distracted to qualify for a personal care assistant.

Emyle Watkins:

Last week, BTPM NPR obtained the response letter CMS requested from New York State. New York pointed out in that letter sent a week before CMS admitted publicly that their math was wrong. The state also addressed other allegations, such as the level of need for accessing personal care services.

Todd Vaarwerk:

We can't turn around and say that the parameters currently are not stringent.

Emyle Watkins:

In 2025, the state increased how many activities of daily living or ADLs, such as bathing, cooking, and dressing a person must be unable to do to qualify for personal care services. Most people now need to be unable to do three tasks to qualify, but according to the state's letter, between 75 and 80% of recipients need support with an average of seven to nine ADLs. This state and Vaarwerk also point out providing personal care is also cheaper.

Todd Vaarwerk:

Advocates for people with disabilities have been very clear about the fact that services in the community are cheaper and more effective than services provided in an institution.

Emyle Watkins:

According to New York's letter to CMS, in 2025, the average spending on personal care per capita in New York was almost $33,000. The average for nursing homes, however, was around $56,000. New York also made significant changes to its largest home care program in 2025. According to the state, this was to improve oversight and reduce costs. New York's changes have left many with concerns about their ability to access the program under a new single company managing their services. Many people with disabilities also want to see their tax dollars used effectively. Vaarwerk points out if the state or federal government want to make these programs more cost-effective-

Todd Vaarwerk:

You're going to be talking about changes that are going to affect my community and my life. So how about getting some of those people involved in that conversation?

Emyle Watkins:

For more on this story, visit our website at btpm.org. I'm Emyle Watkins. Thanks for listening.