On November 3, the Director of the Centers for Medicare and Medicaid Services (CMS), Mehmet Oz, posted a video on his Instagram account @droz_cms, showcasing his visit to the Evergreen Adult Day Care Center in Flushing, Queens, which is owned and operated by a Korean team. This visit took place on October 20 and involved delivering a warning letter regarding the center’s compliance with certain regulations. In the video, Oz pointed out discrepancies that raised concerns about the validity of the membership signatures collected for that day, suggesting that the number of individuals present at the center was not consistent with the figures reported.
The founder and current chief advisor of Evergreen, James Koo, had previously denied allegations of over-reporting when interviewed. He explained that the paper sign-in sheets served merely as backups and that the center billed based on electronic records, asserting that two individuals who signed on the days of October 22 and 23 happened to be Alzheimer’s patients.
As seen in the video, upon arriving at the second floor of the center, Oz identified himself to a staff member who claimed to be the floor manager. He informed her that he was representing CMS and stated that the purpose of the letter was due to existing concerns regarding the center’s practices, assuring that ongoing monitoring of the facility would take place. After surveying the area, Oz estimated that roughly 25 individuals were present and questioned why the attendance was so low. A staff member responded that some members were out shopping. Oz expressed skepticism regarding the center’s claims of millions of dollars in reported revenue, noting the incongruence with the minimal number of attendees.
Later, Oz examined the paper sign-in sheets and pointed to instances where signatures were recorded for dates prior to the visit. Staff explained that some members suffering from dementia occasionally signed in without the staff’s awareness. However, Oz did not accept this explanation at face value, pressing further by questioning, “Is this fraud, do you agree?” The staff member replied affirmatively, adding that some individuals might sign in without the staff knowing. Oz subsequently characterized this exchange as an acknowledgment of fraudulent activity; however, the video did not disclose whether those signatures were used in billing Medicaid.
In a prior statement, Koo acknowledged that there were indeed two members with Alzheimer’s who mistakenly signed on non-attendance days, but he emphasized that billing was predicated on the electronic system in place. He noted that the center had intended to present its electronic records to Oz but was not granted the opportunity for review. Regarding the low attendance he observed, Koo explained that members must attend on dates pre-approved by their insurance plans. Furthermore, he mentioned that he has sold the company and now serves in an advisory role.
On October 20, the New York State government announced its collaboration with federal agencies to investigate suspected Medicaid fraud in social adult day care services.
According to a letter obtained previously by CMS, sent to over a hundred day care centers, CMS indicated that through data analysis, it had detected that the billing amounts received from this center were significantly higher than those of its peers throughout New York State. Consequently, CMS advised these operators to self-audit their billing and service records. The letter insisted that operators ensure their billing data was accurate and complete, supporting every claim with documentation, and complying with applicable billing and coding requirements. It also stated that operators must cooperate with CMS or state authorities if requested for review, although the notification itself does not imply any confirmation of wrongdoing.