The New York Home Care Machine
New York's home care industry is unlike anything else in American healthcare. Dozens of Brooklyn-based agencies each bill Medicaid hundreds of millions of dollars. One provider billed over $7 billion in seven years. The state accounts for 90% of the top 100 personal care billers.
90
NY in top 100
$48.24B
NY T1019 spending
43
Brooklyn agencies
$20.27B
Brooklyn spending
Procedure code T1019 — "Personal care services, per 15 minutes" — is one of the most heavily billed codes in all of Medicaid. It covers home health aides who help with daily activities: bathing, dressing, meal preparation, medication reminders. In New York, this code is the backbone of a massive home care industry driven largely by the Consumer Directed Personal Assistance Program (CDPAP).
The scale is staggering
The top 100 T1019 billers in Medicaid received $58.92B over seven years. New York providers account for 90% of this list and 82% of the total spending. The single largest biller — based in Latham, NY — received $2.70B with 36.5M claims.
Brooklyn is the epicenter. 43 of the top 100 billers are based in Brooklyn, collectively billing $20.27B. Other NYC boroughs — Queens (Flushing, Forest Hills, Rego Park), the Bronx, and Manhattan — add even more. The concentration of home care agencies in New York City is unmatched anywhere in the country.
The CDPAP factor
New York's Consumer Directed Personal Assistance Program allows Medicaid beneficiaries to hire their own caregivers — including family members. This has driven explosive growth in home care spending. CDPAP agencies serve as fiscal intermediaries, processing payments for thousands of individual caregivers. This model explains why individual agencies can bill billions: they're not employing the caregivers directly, they're processing their paperwork and payroll.
The numbers reveal an industry operating at enormous scale. The top provider served 2.2M beneficiaries over 84 months. Even the 100th-ranked provider billed $191.0M. In most states, the largest home care provider wouldn't crack the top 50 of this list.
Fraud concerns
New York's home care system has been the subject of multiple fraud investigations. In 2023, several CDPAP agencies were charged with billing for services never provided. The sheer volume of billing makes oversight difficult — when a single agency processes millions of claims, detecting fraudulent ones becomes a needle-in-a-haystack problem. This data doesn't prove fraud, but the scale demands scrutiny.
Top 20 Personal Care Billers
All 100 Top T1019 Personal Care Billers
| # | Provider | Location | Total Paid | Claims | Beneficiaries |
|---|---|---|---|---|---|
| 1 | NPI 1376609297 | STOUGHTON, MA | $5.46B | 61.8M | 2.2M |
| 2 | NPI 1922467554 | NEW HYDE PARK, NY | $3.00B | 21.9M | 1.2M |
| 3 | NPI 1417262056 | LATHAM, NY | $2.70B | 36.5M | 1.9M |
| 4 | NPI 1962650622 | FLUSHING, NY | $1.62B | 11.0M | 454K |
| 5 | NPI 1720151046 | NEW YORK, NY | $1.30B | 7.2M | 321K |
| 6 | NPI 1396051694 | BROOKLYN, NY | $1.27B | 8.8M | 419K |
| 7 | NPI 1275657553 | BROOKLYN, NY | $1.08B | 7.5M | 372K |
| 8 | NPI 1376097303 | CORONA, NY | $1.07B | 6.6M | 291K |
| 9 | NPI 1518098359 | AMHERST, MA | $1.03B | 11.1M | 399K |
| 10 | NPI 1780816991 | BROOKLYN, NY | $990.8M | 6.5M | 300K |
| 11 | NPI 1518049485 | FOREST HILLS, NY | $977.0M | 5.5M | 282K |
| 12 | NPI 1083783013 | NEW YORK, NY | $952.5M | 5.3M | 236K |
| 13 | NPI 1184703415 | NEW YORK, NY | $945.8M | 4.6M | 211K |
| 14 | NPI 1457410904 | FOREST HILLS, NY | $904.4M | 5.4M | 243K |
| 15 | NPI 1033571658 | GREAT NECK, NY | $831.2M | 5.7M | 243K |
| 16 | NPI 1710176151 | STURGIS, MI | $825.6M | 12.4M | 609K |
| 17 | NPI 1801060363 | BROOKLYN, NY | $775.7M | 5.2M | 236K |
| 18 | NPI 1730438706 | BROOKLYN, NY | $764.6M | 4.7M | 216K |
| 19 | NPI 1871821710 | BROOKLYN, NY | $763.7M | 4.4M | 228K |
| 20 | NPI 1770022691 | BROOKLYN, NY | $753.2M | 5.6M | 255K |
| 21 | NPI 1457562811 | BROOKLYN, NY | $732.3M | 4.7M | 195K |
| 22 | NPI 1992920417 | DANVERS, MA | $721.0M | 9.1M | 401K |
| 23 | NPI 1528315397 | BROOKLYN, NY | $714.1M | 4.6M | 191K |
| 24 | NPI 1528338282 | BROOKLYN, NY | $713.1M | 4.7M | 224K |
| 25 | NPI 1063812105 | FLUSHING, NY | $702.5M | 5.3M | 228K |
| 26 | NPI 1104253558 | HACKENSACK, NJ | $690.6M | 8.1M | 388K |
| 27 | NPI 1447393319 | BROOKLYN, NY | $685.0M | 3.9M | 184K |
| 28 | NPI 1821275801 | BROOKLYN, NY | $669.0M | 3.9M | 183K |
| 29 | NPI 1265926687 | NEW YORK, NY | $664.6M | 4.9M | 253K |
| 30 | NPI 1932106010 | LONG ISLAND CITY, NY | $612.3M | 3.0M | 133K |
| 31 | NPI 1730244294 | LEVITTOWN, NY | $604.8M | 3.5M | 153K |
| 32 | NPI 1649363342 | BROOKLYN, NY | $575.8M | 3.3M | 160K |
| 33 | NPI 1194165985 | MONSEY, NY | $566.6M | 3.6M | 188K |
| 34 | NPI 1508025370 | BRONX, NY | $553.9M | 3.8M | 193K |
| 35 | NPI 1518259035 | BROOKLYN, NY | $539.6M | 3.3M | 180K |
| 36 | NPI 1447488721 | REGO PARK, NY | $532.7M | 3.1M | 124K |
| 37 | NPI 1558781559 | BAYSIDE, NY | $532.7M | 3.7M | 209K |
| 38 | NPI 1275752065 | STOUGHTON, MA | $509.8M | 5.9M | 224K |
| 39 | NPI 1003953803 | BROOKLYN, NY | $501.4M | 2.7M | 119K |
| 40 | NPI 1649462169 | BROOKLYN, NY | $497.7M | 3.1M | 140K |
| 41 | NPI 1487721155 | BROOKLYN, NY | $487.4M | 3.1M | 136K |
| 42 | NPI 1184841926 | NEW YORK, NY | $467.0M | 2.4M | 102K |
| 43 | NPI 1841302445 | BROOKLYN, NY | $461.5M | 2.5M | 126K |
| 44 | NPI 1013377431 | BROOKLYN, NY | $451.9M | 3.0M | 137K |
| 45 | NPI 1467832584 | REGO PARK, NY | $442.6M | 3.3M | 126K |
| 46 | NPI 1639473580 | BROOKLYN, NY | $434.9M | 2.7M | 137K |
| 47 | NPI 1326111337 | MONTGOMERY, AL | $430.6M | 2.5M | 469K |
| 48 | NPI 1740556844 | FLUSHING, NY | $426.8M | 3.2M | 130K |
| 49 | NPI 1477921609 | NEW YORK, NY | $426.2M | 3.2M | 142K |
| 50 | NPI 1326170796 | LYNBROOK, NY | $406.1M | 2.3M | 103K |
| 51 | NPI 1417002007 | BROOKLYN, NY | $405.4M | 2.5M | 130K |
| 52 | NPI 1205378379 | BROOKLYN, NY | $398.2M | 2.9M | 149K |
| 53 | NPI 1619334323 | MISSOULA, MT | $392.6M | 1.9M | 62K |
| 54 | NPI 1750769345 | FOREST HILLS, NY | $386.2M | 2.7M | 116K |
| 55 | NPI 1295842508 | BROOKLYN, NY | $383.6M | 2.0M | 95K |
| 56 | NPI 1538371778 | BRICK, NJ | $383.6M | 2.2M | 131K |
| 57 | NPI 1841739752 | MONROE, NY | $380.3M | 2.9M | 180K |
| 58 | NPI 1780921387 | BROOKLYN, NY | $379.7M | 2.9M | 125K |
| 59 | NPI 1891227203 | JAMAICA, NY | $368.5M | 2.5M | 114K |
| 60 | NPI 1336560390 | BROOKLYN, NY | $349.8M | 2.4M | 121K |
| 61 | NPI 1235677162 | SOUTH OZONE PARK, NY | $330.9M | 2.1M | 105K |
| 62 | NPI 1215934005 | VALLEY STREAM, NY | $327.0M | 1.9M | 101K |
| 63 | NPI 1437541133 | BROOKLYN, NY | $324.8M | 2.3M | 111K |
| 64 | NPI 1841476009 | FOREST HILLS, NY | $320.2M | 1.7M | 77K |
| 65 | NPI 1497014252 | BROOKLYN, NY | $319.9M | 1.6M | 68K |
| 66 | NPI 1619363678 | BRONX, NY | $319.9M | 2.5M | 158K |
| 67 | NPI 1750823381 | BRONX, NY | $319.3M | 2.0M | 90K |
| 68 | NPI 1417406679 | JAMAICA, NY | $309.1M | 2.2M | 90K |
| 69 | NPI 1871651588 | RONKONKOMA, NY | $304.3M | 1.7M | 71K |
| 70 | NPI 1730278409 | BROOKLYN, NY | $281.7M | 1.9M | 80K |
| 71 | NPI 1720471568 | BROOKLYN, NY | $280.5M | 1.9M | 74K |
| 72 | NPI 1952852113 | FLUSHING, NY | $279.1M | 2.1M | 89K |
| 73 | NPI 1225468663 | BROOKLYN, NY | $278.5M | 1.9M | 74K |
| 74 | NPI 1750781076 | BROOKLYN, NY | $267.1M | 2.0M | 93K |
| 75 | NPI 1447575204 | BRONX, NY | $266.8M | 1.4M | 64K |
| 76 | NPI 1538668165 | SPRING VALLEY, NY | $266.7M | 1.8M | 90K |
| 77 | NPI 1982869459 | BROOKLYN, NY | $262.5M | 1.6M | 71K |
| 78 | NPI 1972047181 | NEW YORK, NY | $261.7M | 1.8M | 79K |
| 79 | NPI 1912390931 | BRONX, NY | $254.6M | 1.8M | 90K |
| 80 | NPI 1447510326 | BROOKLYN, NY | $254.0M | 1.5M | 60K |
| 81 | NPI 1174793996 | BAY SIDE, NY | $251.5M | 1.7M | 104K |
| 82 | NPI 1891092649 | BROOKLYN, NY | $250.7M | 1.4M | 63K |
| 83 | NPI 1124186747 | MASSAPEQUA, NY | $244.7M | 1.4M | 63K |
| 84 | NPI 1154788412 | BROOKLYN, NY | $244.3M | 1.8M | 82K |
| 85 | NPI 1982843124 | BROOKLYN, NY | $242.8M | 1.8M | 85K |
| 86 | NPI 1386751162 | YONKERS, NY | $237.8M | 1.4M | 66K |
| 87 | NPI 1619224029 | HEWLETT, NY | $237.5M | 1.4M | 63K |
| 88 | NPI 1033162987 | ALBANY, NY | $237.4M | 1.4M | 64K |
| 89 | NPI 1336117621 | ALBUQUERQUE, NM | $235.0M | 2.9M | 142K |
| 90 | NPI 1649678350 | BROOKLYN, NY | $228.8M | 1.7M | 83K |
| 91 | NPI 1649472853 | BROOKLYN, NY | $228.2M | 1.5M | 63K |
| 92 | NPI 1134455942 | NEW YORK, NY | $228.1M | 1.6M | 67K |
| 93 | NPI 1902341050 | BROOKLYN, NY | $214.6M | 1.6M | 75K |
| 94 | NPI 1790082410 | FOREST HILLS, NY | $213.2M | 1.5M | 63K |
| 95 | NPI 1679606735 | BROOKLYN, NY | $211.6M | 1.2M | 54K |
| 96 | NPI 1568910677 | BROOKLYN, NY | $205.8M | 1.4M | 56K |
| 97 | NPI 1588804405 | BROOKLYN, NY | $204.4M | 1.2M | 51K |
| 98 | NPI 1750827127 | WOODSIDE, NY | $197.7M | 1.2M | 51K |
| 99 | NPI 1942694948 | BROOKLYN, NY | $191.0M | 1.1M | 58K |
| 100 | NPI 1962585638 | WHITE PLAINS, NY | $191.0M | 1.1M | 53K |
Key Takeaways
- ▸New York accounts for 90 of the top 100 T1019 billers and 82% of spending ($48.24B).
- ▸Brooklyn alone has 43 agencies in the top 100, billing a combined $20.27B.
- ▸The CDPAP program, which lets beneficiaries hire family as caregivers, drives much of this spending. Agencies act as fiscal intermediaries processing billions in payments.
- ▸The total across all 100 top billers: $58.92B — serving 20.7M beneficiaries.
Source: HHS Medicaid Provider Spending Data (2018–2024) · 227M records