Home Healthcare Fraud Unveiled by DOH and PPL in Previous Programs

Home Healthcare Fraud Unveiled by DOH and PPL in Previous Programs

The Consumer Directed Personal Assistance Program (CDPAP) in New York State is undergoing a significant change, with all Medicaid recipients and their care providers set to transfer to a single statewide fiscal intermediary, Public Partnerships LLC (PPL), by August 1, 2025[1][2]. This transition, mandated by the 2024 state budget, aims to streamline the program and improve its efficiency[1].

The move to PPL has been met with controversy and resistance. A class action lawsuit was filed against the New York State Department of Health, accusing it of failing to provide proper written notice and due process before terminating contracts with prior fiscal intermediaries[3]. The lawsuit led to delays and deadline extensions for the transition, and a federal judge preliminarily approved a settlement in July 2025. The settlement will provide outreach and resources to assist consumers in navigating the transition[3].

PPL, the sole fiscal intermediary approved by the state for the program, has already identified dozens of fraud cases that were initially obscured by the number of financial intermediaries previously allowed[2]. The company's billing system is designed to prevent such situations from occurring in the future[1].

The transition to PPL has resulted in several notable improvements. As of July 14, approximately 206,000 consumers are registered with PPL, and 99.7% of registered personal assistants have been paid to date[1][2]. The move has also reduced administrative costs, saving taxpayers over $1 billion per year[1].

However, concerns have been raised about the impacts on consumer rights, notification, and access to services, as well as operational difficulties during the rapid transition process[1][2][3][4]. The state Department of Health and PPL have identified more than 30 instances where personal assistants billed patients who were dead or hospitalized[1].

Advocates against the planned switch are angered by a lack of outreach to members of the disability community and those who use the program[4]. Personal assistants have until Aug. 15 to make the switch[1]. The DOH is still combing through records to identify fraud trends within the system[1].

Gov. Kathy Hochul believes the move to PPL will cut down on "waste, fraud and abuse" in the state's healthcare budget[1]. PPL Vice President of Government Relations Patricia Byrnes said there were inconsistencies that needed to be addressed to make the system fair, implying the possibility of fraud, waste, and abuse in the program[1].

Notably, five instances were found where assistants logged time worked even though they were out of the country, and one case was discovered where a personal assistant logged time showing them in two places at once[1]. Another case involved a personal assistant logging time for two consumers on different health insurance plans at once[1].

As of now, approximately 80,000 consumers have transitioned to personal care services[1]. With the deadline fast approaching, it remains to be seen how the transition to PPL will unfold and what impact it will have on the CDPAP and its beneficiaries.

[1] New York State Department of Health. (n.d.). Consumer Directed Personal Assistance Program (CDPAP). Retrieved July 15, 2025, from https://www.health.ny.gov/health_care/medicaid/redesign/cdpap/ [2] New York State Department of Health. (n.d.). CDPAP Fiscal Intermediary Transition. Retrieved July 15, 2025, from https://www.health.ny.gov/health_care/medicaid/redesign/cdpap/transition/ [3] New York State Department of Health. (n.d.). CDPAP Class Action Lawsuit Settlement. Retrieved July 15, 2025, from https://www.health.ny.gov/health_care/medicaid/redesign/cdpap/class_action_settlement/ [4] New York State Assembly. (n.d.). A.9656 (Engesser). Retrieved July 15, 2025, from https://nyassembly.gov/leg/?default_fld=&bn=A09656&term=2023&Summary=Y&Actions=Y&Text=Y&Memo=Y&Video=Y&Floor=Y&Vote=Y&Part=Y&Open=Y&History=Y&Bill Text=Y

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