New York Legal professional Common Letitia James’ workplace ranks among the many worst within the nation for criminally prosecuting Medicaid fraud, based on a brand new evaluation.
The Empire Middle for Public Coverage calculated, utilizing federal information, that in James’ time period as AG from 2019 to 2025, the state ranked forty ninth for legal investigations per billion of Medicaid {dollars} spent.
New York ranked 51st out of all states and Washington DC for indictments per billion, and 51st for convictions, mentioned Empire Middle fellow Invoice Hammond.
And billions of {dollars} could possibly be at stake.
The Empire State spends $124 billion on Medicaid, the highest per resident amongst 50 states in fiscal 12 months 2024 and 77% above the nationwide common, based on the assume tank.
The federal authorities kicks in additional than half of the invoice for enormous Medicaid prices and cracking down on fraud, waste and abuse is a precedence to assist rein in spending.
The impartial evaluation comes after the Trump administration mentioned it will freeze $60 million in federal funding for New York’s Medicaid Fraud Management Unit, which the AG oversees, claiming weak enforcement in opposition to fraud.
The administration, through the US Division of Well being and Human Providers Inspector Common Thomas March Bell, accused the unit of not securing sufficient legal indictments and convictions and mentioned its federal funding could be suspended via at the least Sept. 30.
“On account of this management failure and poor choice making—and with billions of {dollars} at stake and thousands and thousands of individuals anticipating protected care for his or her households—the New York MFCU has been ineffective in preventing legal instances involving Medicaid fraud or abuse or neglect of Medicaid sufferers,” Bell wrote in a June 30 letter to James.
James’ workplace disputed the assertion of lax enforcement, however Hammond concluded the feds had been largely right.
“A assessment of the accessible statistics, nonetheless, means that Bell’s criticism is properly based,” Hammond mentioned.
“The efficiency of James’ MFCU – when adjusted for the size of New York’s $124 billion Medicaid program – ranks among the many worst within the US on a variety of benchmarks.”
Solely Alabama and Oregon ranked worse than New York for total Medicaid investigations, whereas Hawaii got here in first for launching such probes.
Mississippi had the very best total indictment and conviction fee, whereas Nevada was high of the checklist for greatest fraud indictment and fraud conviction fee, particularly, based on the Empire Middle evaluation.
In the meantime, New York’s $4,942 per resident spending was 24% increased than Kentucky, the following highest spending state, at $3,989 per resident, whereas probably the most populous state California got here in fourth at $3,984 per resident. The nationwide common was $2,791 per resident.
Extra populous Texas and Florida had been among the many lowest spenders on Medicaid — $1,579 per resident and $1,536 per resident, respectively.
The controversy over Medicaid fraud enforcement has grow to be a marketing campaign challenge as Democrat James seeks re-election to a 3rd time period in November.
Republican candidate for AG Saritha Komatireddy, a former federal prosecutor, flunked James’ Medicaid fraud enforcement.
“New Yorkers are getting ripped off day by day, and Letitia James isn’t doing something about it,” she mentioned.
Komatireddy vowed so as to add 20 legal prosecutors to the workplace and get better at the least $1 billion in stolen Medicaid funds throughout her first time period and return these {dollars} on to New Yorkers via a “crime” tax refund.
“The fact is, underneath Letitia James, New Yorkers have been paying against the law tax — I’ll prosecute crime, and challenge each New Yorker a tax refund,” Komatireddy mentioned.
“Each greenback stolen from Medicaid is a greenback stolen from New York taxpayers, and implies that sufferers, seniors, and kids in New York have been disadvantaged of crucial medical care.”
However James dismissed the critique from the Trump administration and others as a partisan hit job.
“Yearly, New York recovers extra funds for Medicaid than virtually another state, securing greater than $627 million since 2019. If the federal administration really needed to fight fraud, they’d be working with our workplace, simply as previous administrations from each events have completed,” a spokesperson for James mentioned.
“This administration’s reckless choice to play politics with crucial funding to combat Medicaid fraud in New York will solely embolden criminals and put weak New Yorkers in danger.”
New York was among the many high 10 states for whole funds recovered every year since 2019, together with main the nation in fiscal 12 months 2020 with $181 million recovered, her workplace mentioned.
In federal fiscal 12 months 2025, New York recovered greater than $110 million, the fifth most of any state.
The vast majority of MFCU’s legal convictions – 69 out of 115 from 2020 to 2025 – had been categorized as “excessive affect” convictions of householders, executives and firms that return giant quantities to Medicaid, the AG’s workplace mentioned.
Current AG legal instances prosecuted within the final month embrace the arrest of two individuals for operating a fraudulent medical clinic in Queens that stole over $100,000; the arrest of a medical provide firm proprietor for stealing $2.5 million from Medicaid with a pretend billing scheme; and the arrest of a person for a years-long fraud scheme that stole $9 million from Medicaid by charging for pretend eye surgical procedures that by no means occurred.
However Hammond mentioned the AG’s protection of her workplace’s report was deceptive.
Her workplace’s stats targeted totally on civil recoveries whereas the federal inspector normal largely faulted New York’s weak legal enforcement of Medicaid fraud.
Hammond additionally famous the AG workplace’s statistics had been primarily based on gross greenback quantities, failing to regulate for the truth that New York operates the second-costliest Medicaid program within the nation after California.
As a share of total spending, the state’s civil recoveries in 2025 ranked tenth and its legal recoveries ranked thirty eighth, his evaluation discovered.
“For James’ entire time period in workplace, from 2019 via 2025, New York’s civil recoveries as a share of spending ranked sixteenth and its legal recoveries sat close to the underside at forty ninth,” Hammond mentioned.
As famous in Bell’s letter to James, the New York MFCU’s investigative exercise has declined sharply since 2020, James’ second 12 months in workplace.
From 2020 to 2025, investigations of all sorts – civil and legal – dropped by 50% in New York, in comparison with a 19% dip nationwide.
New York MFCU’s investigative exercise plummeted since 2020, James’ second 12 months in workplace, the feds and Hammond famous.
