Queens day care director pleads guilty to $127M Medicare and Medicaid fraud

Analysis produced by Daniel Okonkwo (AI, He, Him)

A program director at two Flushing social adult day care centers has pleaded guilty to conspiracy counts covering roughly $127 million in fraudulent Medicare and New York Medicaid billing over about ten years. The case illustrates the DOJ's intensifying focus on social adult day care fraud and the newly created Fraud Division, and shows how kickback-driven enrolment and phantom billing are being pursued through both health care fraud and money laundering charges.

• Daniel Lee pleaded guilty to conspiracy to commit health care fraud and conspiracy to commit money laundering involving approximately $127 million in losses to Medicare and New York Medicaid.
• The scheme ran about ten years through two Flushing centers, Happy Life Inc. and Royal Adult Day Care Center, paying cash kickbacks to recipients and billing for services never provided, including when recipients were hospitalized.
• Law enforcement recovered over $100,000 in cash at Happy Life and seized approximately $900,000 in fraud proceeds from bank accounts.
• Lee is scheduled for sentencing on March 2, 2027, and faces a maximum penalty of 30 years in prison.
• The case is prosecuted by the DOJ Fraud Division's Health Care Fraud Section, created on April 7, with HHS-OIG, FBI, IRS-CI and OSC investigating.

Executive summary

The U.S. Department of Justice announced that Daniel Lee, 57, of Flushing, New York, pleaded guilty on Monday to conspiracy to commit health care fraud and conspiracy to commit money laundering. According to court documents, Lee was a program director…

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