跟进：CMS向纽约州发合规警告信：限30天答复、90天整改 审计15家成人日托中心发现预填账单

华盛顿——联邦医疗保险与医疗补助服务中心（CMS）10月21日举行简报会，宣布已就纽约州未能妥善监管其联邦医疗保险与医疗补助计划向纽约州发出合规警告信。CMS 医疗补助事务主管兼副署长 Dan Brillman 在简报会上表示，纽约州须在30天内作出答复、90天内达到合规要求，并提交纠正行动计划。彭博法律（Bloomberg Law）报道，CMS在周三公布的这封信中，要求纽约州提交计划，详细说明将如何加强对管理式医疗计划为老年人长期服务计费的监管。

Dan Brillman 在简报会上说：「如果纽约州拿不出纠正行动计划，问题就会从『能不能修好』变成『它到底还能不能修好、这个项目是否还应继续』。」「州长需要认真审视、作出艰难决定——不是在边缘修修补补，这需要大胆而严肃的行动。」他还表示，纽约州在联邦医疗保险与医疗补助计划上的人均支出为全美各州最高，合计每年约1,260亿美元。

审计发现方面，CMS 副主任 Kim Brandt 表示，她对15家所谓的社会成人日间护理中心（SADC）进行了审计，发现有中心为名单上并未到场参加的人员预填了医疗补助计费。Dan Brillman 说，其中一家中心还就轮椅与残疾辅助器具提出申报，「那里根本没有轮椅」，并指出这类日托中心本身并不提供医疗护理。

这封警告信是10月20日联邦与纽约州执法人员对纽约市逾百家社会成人日托机构执行搜查之后的又一步。社会成人日托是一项由 CMS 批准、联邦与州共同出资的非医疗福利，全州约4.5万名医疗补助会员参加、年支出逾5亿美元；皇后区法拉盛与布鲁克林八大道一带是纽约最大的华人聚居区之一，这类中心日常服务的长者中有大量华语老人。CMS 署长 Mehmet Oz 10月20日曾走访皇后区的成人日托中心并当面递交警告信。（GSM 据 CMS 10月21日简报会报道及彭博法律同日报道；本站10月21日已发本事件执法主稿）

CMS Warns New York: 30 Days to Answer, 90 Days to Comply; Audits of 15 Adult Day Care Centers Found Pre-Filled Billing

WASHINGTON — The Centers for Medicare & Medicaid Services (CMS) said at an October 21 press briefing that it has issued a compliance warning letter to the state of New York for failure to oversee its Medicare and Medicaid programs. Dan Brillman, CMS's Director of Medicaid and Deputy Administrator, said New York has 30 days to answer and 90 days to come into compliance with the agency's orders, and must produce a corrective action plan. Bloomberg Law reported that the letter, released Wednesday, requires New York to submit a plan detailing how it will increase oversight of managed care plans' billing for seniors' long-term services.

"If New York can't produce a corrective action plan, the question shifts from how to fix it to whether it can be fixed at all and should this even continue," Brillman said at the briefing. "The governor needs to take a hard look and make hard decisions not around the margins. This requires bold and serious action." He said New York spends more on Medicare and Medicaid programs per resident than any other state, to the tune of $126 billion per year.

CMS Deputy Director Kim Brandt said she conducted audits of 15 social adult day care centers (SADCs) and found pre-filed Medicare and Medicaid billings for listed individuals who were not participants at the centers. Brillman said one center had also filed claims requesting wheelchairs and disability aid: "There were no wheelchairs there," he said, adding that the SADCs do not provide medical care at all.

The warning letter follows the October 20 searches of more than 100 social adult day care providers across New York City by federal, state and local agents. Social adult day care is a non-medical benefit approved and jointly funded by CMS and the state, serving about 45,000 Medicaid members statewide at an annual cost of more than $500 million; Flushing in Queens and Brooklyn's Eighth Avenue corridor are among New York's largest Chinese communities, and many of the seniors served by such centers are Chinese-speaking. CMS Administrator Dr. Mehmet Oz visited adult day care centers in Queens on October 20 and personally delivered warning letters. (GSM, from reporting on the CMS October 21 briefing and Bloomberg Law, October 21; GSM published its main enforcement story on this matter on October 21)

来源：GSM·美国（原文链接）

图片来源：图：纽约皇后区法拉盛缅街站（长岛铁路）站台（资料图）。照片：Pacific Coast Highway，公共领域，经Wikimedia Commons。The platform at Flushing-Main Street station (Long Island Rail Road) in Queens, New York (file photo). Photo: Pacific Coast Highway, public domain, via Wikimedia Commons.

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