PADSA Confidential Member Communication – Industry Integrity & Emerging Fraud Concerns

Industry Integrity & Emerging Fraud Concerns

Dear PADSA Member,

Recent national developments have brought significant federal attention to fraud and misuse of Medicaid funds within adult day and home- and community-based services across several states.

While Pennsylvania has not been publicly identified in these matters, PADSA leadership believes this is an important time to proactively assess whether similar concerns are affecting providers here.

Over the years, members have raised issues such as:

  • Participant steering and improper recruitment practices, for example providing expensive gifts or monetary equivalents to encourage clients to enroll or to switch programs
  • Kickbacks or inappropriate financial arrangements, for example paying clients daily or monthly to attend an adult day center
  • Non-compliance with ADS enhanced requirements (1:5 staffing ratio, RN hours matching waiver clients enrolled, operating an 11-hour/day program, etc.)
  • Other practices that undermine ethical operations

Given the current federal climate and increased scrutiny surrounding Medicaid funding, this may be an appropriate opportunity to elevate legitimate concerns to the appropriate agencies once again.

However, PADSA will only proceed if there is credible, current information from members indicating that issues persist.

We Are Requesting Member Feedback

Please advise:

  • Are you currently experiencing fraud-related or compliance-related concerns?
  • Are previously reported issues still ongoing?
  • Are new patterns emerging in your region?
  • Do you have documentation that could support formal advocacy if necessary?

Please be as specific as possible and provide as much detail, facts, and documentation as you have, as it only strengthens the message.

To maintain discretion and accuracy, please respond by replying directly to this email.

All communications will be handled confidentially within PADSA leadership.

Our goal is not to create alarm, but to protect reputable providers and ensure that unethical practices do not jeopardize funding, public trust, or stability for the Adult Day Services industry in Pennsylvania.

If there are systemic concerns, it is far better that they be addressed strategically and collectively rather than reactively through external enforcement actions.

Thank you for your professionalism and continued commitment to integrity.

Respectfully,

 

Vlada Rubarkh
Vice President
Pennsylvania Adult Day Services Association (PADSA)