🧵THREAD: Is Brooklyn, NY a Medicaid fraud hotspot?
Brooklyn, NY has a home care billing industry that defies belief.
One zip code (11232, Sunset Park) has 30,181 residents and $3.8 BILLION in Medicaid claims. That's $143,000 per man, woman, and child.
What's even stranger is that the average income is $90K, the poverty rate is below 20%, and it is one of the younger zip codes in the area.
Receipts below.👇
As always, patience as I pull together the thread.
Case study NPI 1396051694: AssistCareHome Healthcare Services at 148 39th Street Building 19, 4th Floor.
1.4 billion in claims paid per DOGE data.
Services 6000+ unique beneficiaries a month, files 20 claims per beneficiary, bills 23MM a month.
Nothing on Google Maps about this place.
1396051694,1396051694,T1019,2024-05,6295,133302,23561537.56
1396051694,1396051694,T1019,2024-07,6240,131852,23311281.66
1396051694,1396051694,T1019,2023-03,6735,147135,23138674.52
1396051694,1396051694,T1019,2023-05,6617,146639,23112662.09
1396051694,1396051694,T1019,2023-10,6571,139728,23027910.07
1396051694,1396051694,T1019,2023-08,6632,147905,22893647.71
1396051694,1396051694,T1019,2024-01,6261,130763,22572233.74
Case study NPI 1780816991: NAE EDISON LLC at 946 McDonald Ave. Very similar number of claims paid out, similar number of unique beneficiaries. 6,000+ beneficiaries monthly being serviced at a strip mall without any reviews.
1780816991,1780816991,T1019,2024-05,6405,147364,24876517.68
1780816991,1780816991,T1019,2024-07,6308,141026,24055592.07
1780816991,1780816991,T1019,2024-04,6338,140215,23651552.47
1780816991,1780816991,T1019,2024-06,6467,135892,23404942.73
1780816991,1780816991,T1019,2024-03,6180,137448,23040261.81
Case study NPI 1275657553: Heart to Heart Home Care Inc., at 395 Pearl Street. A convenience store is located there!
You see the identical pattern in claims paid out: ~6,500 unique beneficiaries a month, ~135K claims per month, over 1 billion billed.
1275657553,1275657553,T1019,2024-05,6601,143583,22564791.29
1275657553,1275657553,T1019,2024-07,6687,142653,22542376.21
1275657553,1275657553,T1019,2024-04,6545,136068,21329948.52
1275657553,1275657553,T1019,2024-03,6423,135409,21085422.98
1275657553,1275657553,T1019,2024-11,7006,136497,20928418.06
1275657553,1275657553,T1019,2024-06,6618,131782,20900255.90
1275657553,1275657553,T1019,2024-01,6249,132683,20617339.31
All three exhibited strikingly similar growth patterns. All three jumped by ~30% in October 2019.
Per OpenClaw analysis:
🔹Sept 2019: $276M → Oct 2019: $351M — a 27% jump in one month
🔹Beneficiaries: 94K → 106K (13% jump)
🔹NPIs barely changed (236 → 238) — same agencies, more billing
This was program-wide, not just these three — nationwide T1019 jumped 15% the same month ($1.18B → $1.35B).
OpenClaw concludes what likely happened: NY's minimum wage for NYC hit $15/hour on December 31, 2018 (large employers). The Medicaid reimbursement rates for home care are tied to wage parity requirements — when minimum wage goes up, Medicaid rates follow with a lag. The Oct 2019 timing aligns with rate adjustments flowing through the managed long-term care (MLTC) plans that pay these agencies.
But the rate increase alone doesn't explain a 27% jump. The other factor: CDPAP enrollment was exploding in 2019 as fiscal intermediaries aggressively recruited. This is when it went from $2.5B/year toward the $9B/year Hochul would later call "a racket." The agencies were simultaneously getting paid more per unit AND signing up more beneficiaries.
This pattern is everywhere in Brooklyn.
Case study NPI 1457562811: S&A Unified Home Care at 2729 Coney Island Ave. Serviced 3000+ unique clients monthly at its peak. Still serving almost 2000 a month.
1457562811,1457562811,T1019,2024-08,1832,45076,8448045.90
1457562811,1457562811,T1019,2024-09,1885,44519,8411232.99
1457562811,1457562811,T1019,2024-05,1822,45265,8406442.29
1457562811,1457562811,T1019,2024-11,1965,44958,8379172.36
Right across the street is NPI 1528338282, All American Home Care Agency Inc. at 2784 Coney Island Ave. That one does seem to have a shiny building at least.
1528338282,1528338282,T1019,2024-07,3416,73906,13232587.06
1528338282,1528338282,T1019,2024-05,3341,73144,12862944.39
1528338282,1528338282,T1019,2024-04,3288,69551,12209293.47
1528338282,1528338282,T1019,2024-06,3381,68053,12136241.40
1528338282,1528338282,T1019,2024-01,3160,69215,12027420.06
1528338282,1528338282,T1019,2024-03,3251,68050,11908546.50
Per OpenClaw:
NY is two-thirds of all personal care aide billing in the entire country. And the top 25 zips nationally for T1019 per capita are almost entirely NYC zip codes — with 02072 (Stoughton, MA — Tempus Unlimited HQ) and 12110 (Latham, NY — Public Partnerships HQ) at the top because those fiscal intermediaries register billing at their corporate address.
The postable stat: National median is $3/person/month. Brooklyn 11232 is $2,214. That's 738 times the national median.
Yes, I'm aware that home care agencies do not directly serve clients in those offices.
But when you see few-to-no Google Reviews, a parking garage, etc... compare to other medical administrative facilities.
It's stupefying.
Some context on why NY stands out so much:
OpenClaw doesn't agree that deinstitutionalization is a full explanation though:
Likely the best explanation for it all:
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